Medicaid expansion to begin soon in North Carolina as governor decides to let budget bill become law

North Carolina Gov. Roy Cooper announced Friday he would let the state budget bill coming to his desk become law without his signature, opening the way for Medicaid coverage for 600,000 low-income adults, with some receiving the government health insurance soon.

The Democratic governor unveiled his decision on the two-year spending plan minutes after the Republican-controlled General Assembly gave final legislative approval to the 625-page measure.

A Medicaid expansion law that Cooper signed in March said that a state budget for this fiscal year still had to be enacted before coverage could be implemented.

Negotiations on that budget plan, which was supposed to take effect July 1, carried on throughout the summer.

The final two-year plan accelerates individual income tax rate cuts, broadens private-school scholarships to all K-12 children and contained other items that weaken the governor's office while strengthening the GOP-dominated legislature and its powers involving state courts.

Cooper could have signed the budget, vetoed it or let it become law after waiting 10 days. Cooper said Friday he chose the last option.

Republicans hold narrow veto-proof majorities, and five House Democrats joined all GOP legislators present to vote for the budget measure.

“Make no mistake, overall this is a bad budget that seriously shortchanges our schools, prioritizes power grabs, keeps shady backroom deals secret and blatantly violates the constitution, and many of its provisions will face legal action,” Cooper said in a news release.

“However, we must recognize this irresponsible legislature’s decade of refusal to expand Medicaid, which has caused life and death situations for so many North Carolinians and threatened the very existence of numerous rural hospitals,” he added. “I will not allow people who are crying for help to wait any longer. Cooper said he was directing the Department of Health and Human Services to begin the process for expanding Medicaid based on his budget decision.

Medicaid expansion has been one of Cooper’s top priorities since taking office in early 2017. For years, state Republicans had been strongly opposed to offering Medicaid through the 2010 federal health care law, but GOP leaders reversed course last year, attracted in part to the billions of federal dollars annually that would be injected into state health care and the economy.

Cooper's health secretary suggested last month that Medicaid coverage could be carried out as soon as December should the legislature complete the last step for Medicaid. North Carolina DHHS had no updated information to provide Friday on a start date.

There are currently 2.87 million Medicaid recipients in North Carolina. Adults who earn too much to qualify for traditional Medicaid but too little to receive even heavily subsidized private insurance would benefit from expansion. About 300,000 people could be enrolled automatically on the first day of expansion, Secretary Kody Kinsley has said.

The House and Senate voted Thursday and Friday on the plan that directs how $29.8 billion is spent this fiscal year and $30.9 billion next year.

Senate leader Phil Berger told reporters after Cooper's announcement that he would have preferred the governor sign the budget “to move everything along a little quicker," rather than wait until early October for the budget's enactment.

“But I think that’s an indication that this is a solid budget,” Berger said. "There are some things in the budget I’m not so crazy about ... but on balance, it is in many respects the most significant budget we’ve seen in North Carolina.”

The future of expansion being carried out in North Carolina was uncertain earlier this week as GOP legislative leaders suggested moving the trigger mechanism to begin expansion away from the budget and into a standalone measure that would have dramatically expanded gambling in the state.

But Cooper and both legislative Democrats and social conservatives balked at the idea, threatening the bill's success. Berger and House Speaker Tim Moore ditched the gambling effort late Tuesday.

North Carolina had been among 11 states that haven’t accepted expansion from the federal government before Cooper signed the expansion bill. Cooper and his administration had complained that delays in implementation meant the state was missing out on over $500 million per month in additional federal funding.

State government also will get an additional two-year, $1.8 billion federal payout for expanding Medicaid, offered by the federal government.

The state’s 10% share of expenses for Medicaid expansion recipients would be paid through hospital assessments.

Despite bipartisan support for the original Medicaid law in March, some legislative Republicans remained skeptical of expansion.

“There’s a lot of people on my side that’s going to hold their nose to vote for this budget because expansion’s in there,” GOP Rep. Donny Lambeth, a longtime expansion supporter, said during House debate early Friday. "But they’re looking at the whole, and they’re going to move the needle forward to try to get this done.”