NC approves Medicaid expansion, reversing long opposition

RALEIGH, NC (AP) — A Medicaid expansion deal North Carolina got final legislative approval Thursday, ending a decade-long debate over whether the politically divided state should accept federal protections for hundreds of thousands of low-income adults.

North Carolina is one of several Republican-led states to begin considering expanding Medicaid after years of staunch opposition. Voters in South Dakota approved the expansion in a referendum November. And in Alabama, advocates are urging lawmakers to take advantage of federal incentives to expand Medicaid to provide health insurance to more working people.

Democratic Gov. Roy Cooper, a longtime expansion advocate, signed the bill, leaving 10 states in the U.S. that have not adopted expansion. North Carolina has 2.9 million enrollees in traditional Medicare. Advocates estimate the expansion could help 600,000 adults.

“Medicaid expansion is a generational investment that will make all North Carolina families healthier while strengthening our economy, and I look forward to signing this legislation soon,” Cooper tweeted.

The final bill for expansion under the law has no start date, but it still comes with a caveat: It can’t happen until the state budget is approved. This usually happens in early summer. Cooper vetoed that provision, which would have given GOP leaders the ability to include unrelated items that he strongly opposes.

The The House voted 87-24 After little debate and a preliminary vote Wednesday, in favor of the deal. After it passed, which is not normally allowed under House rules, several Democrats stood on the floor and applauded. Nearly two-thirds of House Republicans voted yes. The Senate already unanimously approved the legislation last week.

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Final Agreement That includes rolling back or eliminating regulations that state health officials must sign off on before medical providers can open certain new beds or use equipment. Senate Republicans have called for “certificate of need” changes in any deal.

For years, Republicans in charge of the General Assembly have been skeptical of the expansion stemming from the federal Affordable Care Act, signed into law by President Barack Obama 13 years ago Thursday.

GOP lawmakers passed a law in 2013 specifically barring a governor’s administration from seeking an expansion without the express approval of the General Assembly. But interest in the expansion has grown over the past year as lawmakers decided that Congress was unlikely to repeal the law or raise the match for the lowest 10% of states requiring coverage.

A funding sweetener in the Covid-19 Recovery Act that expands Medicaid would also see North Carolina get an additional $1.75 billion in cash over two years. Legislators hope to use most of that money for mental health services.

A turning point came last May when Senate President Bill Berger, a longtime expansion opponent, publicly explained his reversal.It is mostly based on financial terms.

At a news conference, Berger also described the situation facing a single mother who doesn’t make enough money to cover herself and her children, which means she ends up in the emergency room or not getting care, she said. . The expansion covers people who make too much money to pay for regular Medicaid, but not enough to benefit from more subsidized private insurance.

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“The working poor need protection in North Carolina,” Berger said at the time.

The Senate and House approved competing measures in 2022, but negotiations stalled on certification of the requirement changes. Berger and House Speaker Tim Moore announced a deal three weeks ago.

In 2019, Cooper’s insistence on advancing the expansion contributed to a state budget impasse with GOP lawmakers that has never been fully resolved.

House Minority Leader Robert Reeves of Chatham County shied away from the budget-passage requirement for expansion, but wanted to be celebratory.

“I’m really happy because health means everything,” Reeves said. “Now we all have a responsibility to put together a budget document that everyone can live with.”

The state’s 10% share of costs for Medicaid expansion recipients will be paid through hospital assessments. Hospitals are expected to receive large amounts of money from the federal program to treat Medicaid patients.

The proceeds from this project will help improve many closed rural hospitals.

“This landmark legislation will have lasting benefits for our state by helping hard-working North Carolina families, stabilizing rural health care providers and improving the overall health of our communities,” said Steve Lawler with the North Carolina Healthcare Association, which represents hospitals and hospital systems.

In a news release, Moore called Thursday’s passage “a historic step to increase health care access for our rural communities,” and said he looks forward to passing “a strong conservative budget” so the expansion can begin.

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