Medicaid expansion bill debate is renewed in North Carolina

The North Carolina General Assembly began on Tuesday what could become the final push to expand Medicaid to hundreds of thousands of low-income adults in the state with a House measure that quickly advanced through committee with bipartisan support.

The legislation scheduled for debate on the House floor Wednesday would direct the state to accept Medicaid coverage for adults who make too much to qualify for conventional Medicaid but not enough to receive heavily subsidized health insurance that the 2010 Affordable Care Act provides. North Carolina is among 11 states that haven’t adopted Medicaid expansion.

“We’re fighting to pass this bill to help people in North Carolina have a better standard of living (and) get better health care,” Rep. Donny Lambeth, a Forsyth County Republican and chief bill sponsor, told the House Health Committee. “Let’s really make a difference in North Carolina.”

The Medicaid expansion question has been discussed in the state for over a decade, with Republicans in charge of the General Assembly usually blocking the idea and Democrats led by Gov. Roy Cooper pleading for them to enact. But GOP heavyweights, in particular Senate leader Phil Berger, have come around to the idea recently.

Last year, both chambers overwhelmingly approved competing expansion measures that never got boiled down to a compromise. Senate Republicans insisted any package contain provisions designed to ease “certificate of need” laws that require health regulators to sign off on expansion plans by medical providers. The Senate also wants to give some specialty nurses independence to practice without a physician’s supervision.

Tuesday’s House bill contained neither, as Lambeth has said House GOP leaders wanted a streamlined expansion measure that more Republicans in the chamber could support. But Lambeth said he expects add-ons will be considered again by the Senate, with the goal to hammer out a final agreement.

“My guess is we’ll come out with a comprehensive bill that will include more than just expansion at some point,” Lambeth told reporters after the health committee approved the measure after barely 15 minutes of discussion on a voice vote that contained a few “nos."

The measure would direct the state starting next January to cover applicants who would qualify for expansion — potentially up to 600,000 people — under the 2010 federal healthcare law through a program named NC Health Works.

The federal government covers 90% of the cost of Medicaid recipients under expansion. The bill would again pay for the state’s 10% share through assessments paid by hospitals, which in turn benefit from getting reimbursed as they cover more Medicaid patients.

The state also could get an extra $1.5 billion over two years through a financial sweetener in a COVID-19 federal relief package if it accepts expansion. About half of that money could be earmarked for mental health services, said Rep. Wayne Sasser of Stanly County, a health committee chairman.

The measure does contain a provision sought by the Senate and the state's hospitals that would result in higher reimbursements — potentially $3 billion annually — for hospital systems when they treat Medicaid patients.

The House bill also doesn't include a work requirement for enrollees. But it directs the state to beef up workforce development initiatives as enrollees seek to return to employment or establish new careers.

All but six Republicans voted for last year's House expansion bill, which actually wouldn't have enacted expansion. Instead, it would have directed a vote six months later on a package presented by health officials in Cooper's administration.

While Lambeth still expected a strong bipartisan vote to approve the current bill on Wednesday, he acknowledged many Republican colleagues still have reservations about expansion. House Republicans meeting privately on Monday discussed expansion for over three hours, he said.

North Carolina state Medicaid enrollment is 2.9 million. The state Department of Health and Human Services had said up to 300,000 current beneficiaries could lose full healthcare coverage as the federal government ends a pandemic-era prohibition on removing people from the Medicaid rolls and requiring states to conduct annual eligibility verifications.

The first enrollees could lose coverage under this change starting July 1, but DHHS said many being removed would qualify through Medicaid expansion. Lambeth said passing Medicaid expansion in early 2023 could mean avoiding the laborious process of re-enrolling those who would qualify.