CONCORD, N.H. (AP) — A commission studying the future of New Hampshire's expanded Medicaid program is recommending that it continue for five years, but move toward a fully managed care model in 2019.

After two years of work, a committee of lawmakers, insurance officials and health care providers on Wednesday signed off on its final report, which will be used as the basis for legislation taken up next year.

The current expanded Medicaid program uses federal money to put about 43,000 low-income people on private insurance, but it will end in December 2018 if lawmakers don't reauthorize it.

The commission said switching to managed care would provide more straight-forward opportunities to address premium increases in the individual market and consistent benefits for all Medicaid participants. They also hope doing so would increase competition among managed care companies because there would be a larger pool of people needing coverage.

New Hampshire's traditional Medicaid program is a managed care program in which the state pays two insurers a set amount to care for Medicaid clients. When the state expanded Medicaid under the Affordable Care Act to include low-income adults under age 65, it used federal money to put the new participants on private insurance plans in the individual market. The committee is recommending that the expansion population be moved to the managed care model as well.

Republican state Sen. Jeb Bradley compared the report to a baseball player facing three balls and two strikes who advances via a walk.

"We've gotten to first base," said Bradley, of Wolfeboro. "That's a good place to be but there's a long ways to go. We're going to have to do a lot of work."

The report also recommends higher reimbursement rates for those who provide mental health and substance use disorder services, and a transition period during which participants are assured coverage. The committee said managed care companies also should be required to help Medicaid recipients apply for new coverage if their income rises and they are no longer eligible for Medicaid.

The report does not make any recommendations on how to pay for the program. Federal officials recently expressed concern that New Hampshire may be out of compliance with federal rules because it relied on voluntary contributions from insurance companies and hospitals to cover some of the state's costs.

New Hampshire also is one of eight states seeking a waiver from the federal government to add a work requirement for Medicaid recipients, something the administrator of the Centers for Medicare and Medicaid Services recently said she was open to.

The committee's report was approved by a unanimous vote, though Sen. Sharon Carson, R-Londonderry, said she remains skeptical.

"I will go ahead and vote to move this forward because we're moving in a good direction," she said.