Medicaid expansion in North Carolina will begin Oct. 1, if lawmakers can enact a budget

Gov. Roy Cooper's administration is aiming to extend Medicaid coverage to hundreds of thousands of low-income adults starting Oct. 1, but that date depends on lawmakers completing the last step necessary to implement the expansion legislation he signed into law months ago.

The state Department of Health and Human Services revealed on Wednesday that it's got an agreement with federal Medicaid regulators to begin expansion quickly once elected officials complete what's needed to carry it out.

“Having a clear date and beginning that work now is going to allow us to get folks on (coverage) and really maximize the benefit as soon as possible,” DHHS Secretary Kody Kinsley told The Associated Press.

The Medicaid expansion legislation passed by the Republican-controlled General Assembly and signed by the Democratic governor will extend the government-funded health coverage to as many as 600,000 adults who earn too much to qualify for traditional Medicaid but too little to receive even heavily subsidized private insurance.

The legislation contains a provision requiring that a separate state budget law also be enacted before expansion can be accepted from the federal government and implemented. That budget was supposed to be in place by June 30, but House and Senate Republicans are still negotiating over tax cuts and how to earmarks billions of dollars into reserves.

The Oct. 1 start date can happen as long as his agency receives formal authority by elected officials to move forward by Sept. 1, Kinsley said. Otherwise, the next start date would have to be Dec. 1, or even early 2024 if action is delayed significantly.

Unhappy with the legislative delay, Cooper and other Democrats have urged lawmakers to decouple the Medicaid expansion implementation from the budget, saying the state is missing out on more than $500 million in federal funding for each month that expansion isn’t implemented. GOP lawmakers have no plans to separate the two issues.

The legislature hasn't held votes in weeks while negotiations continue. Lawmakers are now expected to return to Raleigh in early August.

Kinsley said legislative leaders, in particular health-policy chiefs, have been kept in the loop and “are completely aware that I am making this move forward and supported the work we're doing to help North Carolina."

DHHS said it would have taken 90 to 120 days to implement Medicaid expansion, but the agreement with the Centers for Medicare & Medicaid will drop it to 30 days because the state is starting the required public notices for beneficiaries, counties and health care providers, including opening a period for public comments on the state's plans.

North Carolina currently has 2.9 million Medicaid recipients. Under Medicaid expansion, adults aged 19-64 with incomes up to 138% of the federal poverty level — about $20,000 for a single person or $34,000 for a family of three for example — also can qualify.

The state already has a Medicaid program for family planning benefits such as contraception, annual exams and tests for pregnancy and diseases — it doesn't cover abortion — that is available to people who make well over poverty levels. Kinsley said he anticipates that some 300,000 of these people who are already in the system and meet the new income requirements will automatically have access to full Medicaid benefits once the expansion begins.

Kinsley said he also expects that many of the people being removed from the traditional Medicaid rolls due to income now that eligibility reviews are required again by the federal government following the end of the COVID-19 pandemic will be quickly returned to coverage under expansion.

In the last month alone, 9,000 people have left the Medicaid rolls, and could have remained had expansion been in place, Kinsley said.

Cooper had made expansion a top priority since entering the Executive Mansion in early 2017. When he signed the Medicaid law, North Carolina was among 11 states that hadn’t accepted the federal program. Republicans in charge of the General Assembly remained skeptical of expansion, which originated from the 2010 Affordable Care Act. A deadlock over expansion meant no traditional state budget was ever passed in 2019.

But GOP leaders recently came around to supporting expansion — attracted largely to the cash injections that it will bring. The state will also get an additional two-year, $1.8 billion federal payout for expanding Medicaid, but only as it's carried out.