Medicaid back in spotlightNC House files Medicaid expansion bill focused on financial elements
The
Clean, in this instance, means no additional health-care reform language remains in House Bill 76 - a major component of Senate Republican leaders' quid-pro-quo preference for Medicaid expansion.
HB76, titled "Access to Healthcare Options," has Rep.
The bill was filed without comment by House speaker
Lambeth said the plan is to have HB76 take the fast-track committee approach early next week, clearing the Health, Finance and Rules and Operations committees to "have it on the House floor for its first vote no later than Wednesday."
Lambeth said HB76 is "a good option for
"The expansion benefits many of our citizens, including veterans, farmers and many others who work, but cannot afford private insurance. This is a win-win."
Lambeth said part of HB76's appeal is the "focus on preventive and well care, encouraging participants to take care of their selves.
"It will also direct the
Background
Lambeth has pursued some form of Medicaid expansion since 2014.
Early bill versions didn't dare to cite expansion as the end goal because of then-rigid opposition from the majority of top Republican legislators, foremost
"I believe we have some common components and a common understanding that it is time for
"We have transformed N.C. Medicaid to a risk-based model of care which has saved tens of millions of dollars for taxpayers of our state and have fixed a broken system.
"Now, it is time to move to the next step which covers those who need help."
The bill's main focus is on the financial aspect of filling the coverage gap that represents "a combination of intergovernmental transfers, hospital assessments, gross premiums tax revenue and federal funds."
Hospital assessments have been a negotiating sticking point over the past nine years, even though the state's major health-care systems have agreed to the assessments with the expectation that the additional federal Medicaid administrative funding will more than offset the annual expense.
Moore has said the House's Medicaid expansion plan would help preserve rural hospitals and further modernize the state program.
"We need to know exactly what we're getting" from Medicaid expansion, particularly in terms of expanding access to health-care providers "in a manner that is cost-effective," Moore said in August.
"This way, we have certainty ... and the final say."
Rep.
The statewide Care4Carolina coalition said Wednesday that it "applauds the leadership of the
"In introducing HB76, House leadership has demonstrated their commitment to helping hundreds of thousands of North Carolinians who are currently in the gap, including working parents, small businesses across the state and 14,000 of our veterans."
Meanwhile, a Senate Medicaid expansion bill has not been reintroduced as of Wednesday.
Berger became in 2022 a convert to the need for Medicaid expansion, particularly among the working poor.
However, Berger has made it clear his expansion support is tied directly to reform legislation.
There have been three health-care reform bills filed so far in the 2023 session - focused on regulating hospital consolidation, enhancing medical bill transparency and eliminating the state's controversial certificate-of-need (CON) laws - that could be inserted into an expansion bill.
Other previous reform bills would permit nurse practitioners, certified nurse midwives and other providers the ability to work independently from doctors.
The CON reform efforts, led by Sen.
Analysts say the
Berger said when he introduced the revamped HB149 that "if there's a person in the state of
HB149, however, is vigorously opposed by the
In August, NCHA president and chief executive
Lawler wrote that the NCHA "hopes to see the
"They are both important to the state, and should not require a trade or a change in policy that would likely have negative downstream impact on hospitals that are crucial to the state's safety net."
Delay consequences
The lack of progress has two meaningful consequences attached to them.
The first was cited by a letter sent in September by state Health Secretary
A pivotal turning point in Berger and Moore agreeing to consider Medicaid expansion was the potential for the federal pandemic relief law to provide
That funding is contingent on the Republican-controlled legislature approving expansion and, most important, agreeing to not put stipulations on enrollees, such as work requirement for some potential recipient that has been blocked by several federal judges.
Those federal funds would free up DHHS to re-direct General Fund dollars to other priorities;
Kinsley cited at the time of his letter the need to pass some form of Medicaid expansion by
Expiring coverage
Medicaid covers 2.71 million North Carolinians, which increased by nearly 27% or 588,611, since the beginning of the pandemic, according to DHHS.
Those who might be eligible under the expanded program are between the ages of 18 and 64 and earn too much to qualify for Medicaid coverage, but not enough to purchase coverage on the private insurance marketplace.
A sizable portion of enrollees during the pandemic likely would qualify for expansion coverage.
According to the
Part of the act is a requirement that Medicaid programs keep people continuously enrolled through the end of the month in which the COVID-19 public health emergency ends, in exchange for enhanced federal funding.
That has been the pathway where many of the additional Medicaid beneficiaries in N.C. gained coverage during the pandemic.
However, the temporary enrollment has an end date of when the federal DHHS - first the Trump administration and now the Biden administration - declares the national public health emergency as over.
A
Kaiser estimates that millions of uninsured beneficiaries nationwide will lose their health coverage at that time.
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