North Carolina Medicaid expansion consensus moves forward

RALEIGH, N.C. (AP) — The details of a consensus North Carolina Medicaid expansion deal reached last week by top Republican lawmakers cleared a Senate committee Tuesday.

The released legislation explains how the state would cover potentially 600,000 low-income adults who otherwise earn too much to qualify for conventional Medicaid. It directs the state to enter a federal program by which hospitals would receive additional Medicaid reimbursement funds. This money will help hospitals cover the state’s share of expansion health expenses, or 10% of costs.

The bill also details where “certificate of need” laws that require health regulators to sign off on plans for medical entities to build locations or purchase equipment would be loosened or eliminated altogether. Senate Republicans insisted on these changes as a way to boost service supplies for the additional Medicaid enrollees.

Debate over whether North Carolina would accept Medicaid expansion provided through the Affordable Care Act lingered for the past decade, with most Republicans skeptical about the idea for most of that period. Democratic Gov. Roy Cooper has been a strong advocate for it. The tide changed toward expansion last year when the GOP-controlled House and Senate separately passed competing legislation.

The agreement, reached after about four weeks of negotiations, was announced last Thursday by House Speaker Tim Moore and Senate leader Phil Berger. The Senate Health Care Committee approved the legislation Tuesday after about 15 minutes of discussion.

“This really is a monumental day,” said Rep. Donny Lambeth, a Forsyth County Republican and one of the key negotiators. “It has been a bipartisan effort. We’ve fought over it, we’ve discussed it, we’ve cussed it. But it is the right thing to do today.”

North Carolina has been one of 11 states that has not adopted Medicaid expansion. Legislative leaders believe expansion enrollees could begin receiving services next January.

“Six hundred thousand North Carolinians who are mostly working will now be able to lead more healthy and economically secure lives,” Peg O’Connell with Care4Carolina, a coalition of groups that has worked for expansion for several years, told legislators. Additional federal reimbursement funds also should assist rural hospitals that are otherwise struggling financially.

Sen. Ralph Hise, a Mitchell County Republican and another negotiator, said he expected the bill on the Senate floor early next week after two other committees review it. The House then would have to formally vote for the package before it could go to Cooper’s desk.

Even if Cooper signs the measure quickly, the bill’s language states that the portion that provides Medicaid coverage through expansion wouldn’t take effect until a separate state budget bill is enacted into law. That likely won’t happen until early in the summer. Moore and Berger said last week that it makes sense to match budget provisions with expansion, which will lead to billions of dollars in additional spending. It also would discourage Cooper from vetoing the budget bill for fear of blocking expansion.

At Monday’s State of the State address, Cooper urged legislators to enact expansion immediately to ensure state government and the state’s hospitals get federal funds as soon as possible.

The state is already poised to receive an extra $1.8 billion over two years through a financial sweetener in a COVID-19 federal relief package from Congress for states that hadn’t accepted expansion.

North Carolina currently has 2.9 million Medicaid recipients. The state Department of Health and Human Services has said up to 300,000 current beneficiaries could lose full coverage as states soon must conduct annual eligibility verifications again following the COVID-19 pandemic. Hise told reporters Tuesday he guessed that about 100,000 of the 300,000 would be able to qualify again for Medicaid through expansion.

The “certificate of need” changes would eliminate state review of plans to build or expand psychiatric and substance abuse treatment facilities and to replace medical equipment of up to $3 million. In the years ahead, ambulatory surgical centers and MRI machines also wouldn’t be subject to review in certain circumstances.