Medicaid expansion back on glidepath to enactment in North Carolina as final budget heads to votes

Passing North Carolina's budget will remain the last hurdle for the state to expand Medicaid to potentially cover 600,000 adults who don't qualify or make enough for health insurance now that an effort to link it to authorizing more casinos is off the table.

Expansion appears back on a smoother glidepath after Republican legislative leaders said late Tuesday that they would stick to language within the landmark Medicaid expansion bill that Democratic Gov. Roy Cooper signed in March. That law said Medicaid would take effect only after the state budget covering this fiscal year was enacted.

The final negotiated two-year spending plan will be voted on Thursday and Friday, then it heads to Cooper’s desk.

That's good news for Lisa Franklin, who has lacked Medicaid since her son turned 18 earlier this year but is dealing with liver failure and the possibility of a transplant while facing medical debt. She traveled Wednesday to the legislative offices of Senate leader Phil Berger and House Speaker Tim Moore to make the case for expansion to help people like her.

“I’ve got lots of tests and other stuff coming up that I can’t have done. I’m having to pick and choose what tests and procedures that I can do,” Franklin, 41, of Forest City, said after speaking to a Berger staffer. “We need this Medicaid expansion enacted in North Carolina, and we need it now.”

Just because the budget's enactment still will get Medicaid expansion — one of Cooper's top priorities — across the finish line doesn't mean it will be easy for Democrats to vote for the plan. It's going to include Republican priorities on reducing taxes and expanding school choice, as well as items that strengthen power of the legislature and the courts.

“We want Medicaid expansion, but not at the price of so many horrible things,” state Rep. Marcia Morey, a Durham County Democrat, said Wednesday.

Cooper said last week he didn't know whether he would veto the budget. Republicans hold narrow veto-proof majorities in both chambers, and Moore and Berger said they anticipated all Republicans and even some Democrats to vote for the plan.

Republicans have a different take on the budget, the final edition of which was released Wednesday afternoon — its text and a related financial document covering more than 1,400 pages. The package directs how the state spends $29.8 billion this fiscal year and $30.9 billion the following year.

The individual income tax rate would drop from the current 4.75% to 3.99% by 2026, rather than the 2027 date currently in state law. And it could drop as low as 2.49% in the years after if revenue collection thresholds are met.

The program giving taxpayer-funded scholarships to children in low- and middle-income families to attend private schools would now be available to all families with K-12 students.

Rank-and-file state employees would get a 4% raise this year and a 3% raise next year, while average teacher salaries would grow by at least 7% over two years. The plan also sets aside $2 billion for 200 water and wastewater infrastructure projects.

“We’re very proud of this budget," Moore said. “It’s going to lower taxes. It’s going to invest in our infrastructure from one end of the state to the other ... and make a wise use of North Carolina’s resources that we have to see our state continue to grow and prosper.”

Republican legislative leaders had been trying to get through the General Assembly provisions that would have allowed four more casinos and legalized video gambling machines statewide.

Facing stiff opposition from social conservatives, some Republicans floated the idea of making passage of a standalone bill containing the gambling items the required legislation that had to be passed to trigger implementation of Medicaid expansion. But Cooper and nearly all Democratic legislators opposed the idea as breaking an earlier promise in the original expansion law.

By late Tuesday, Moore and Berger set aside gambling for another day and said the original Medicaid trigger would remain in place.

“Medicaid expansion will still be contingent on the budget becoming law,” Berger said.

A budget was supposed to be in place by July 1, but negotiations continued throughout the summer. The holdup meant that an Oct. 1 target date by state Health and Human Services Secretary Kody Kinsley to begin offering Medicaid was delayed to at least December.

Abby Emanuelson, the leader for Care4Carolina, a coalition of 190 groups that has worked for expansion since 2014, expressed “joy and gratitude" that Medicaid expansion appeared to be on track.

“Once the budget is enacted, we will get on with significantly improving the health of our people, our economy and our entire health care system,” she added.