House Republicans rejected legislation Thursday that would have permanently continued the state’s expanded Medicaid program, which provides nearly 57,000 low-income Granite Staters health insurance. 

The 191-183 vote on Senate Bill 253 leaves the program in place for the next seven years, as agreed to in compromise legislation last year. Lawmakers will have to decide then whether to continue it. One Republican, Rep. Dan Wolf of Newbury, voted with Democrats to make the program permanent while one Democrat, Rep. Matthew Coker of Meredith, voted with Republicans to defeat the bill. 

In a July analysis, the New Hampshire Fiscal Policy Institute credited the Granite Advantage program with lowering the number of uninsured Granite Staters, improving health outcomes by allowing beneficiaries to afford preventative care, and lowering uncompensated medical care costs for hospitals.

Like traditional Medicaid recipients, those on Granite Advantage are low-income. But they don’t meet Medicaid’s other eligibility rules, which require they be younger than 19, pregnant, have a physical or developmental disability, or are caring for children or other family members.

The federal government splits the cost with the state.

Republican lawmakers have rejected efforts to make the program permanent since it was first implemented in 2014. House Republicans reiterated their reasons Thursday on the House floor, saying they want to preserve the option to reconsider the program if the federal government reduces its contribution in the future or changes other policies.