Medicaid-expansion bill clears two committees in the N.C. General Assembly

* Individuals with a physical, intellectual, or developmental disability that significantly impairs the individual's ability to perform one or more activities of daily living.

* Individuals actively participating in a substance abuse treatment and rehabilitation program.

* Parents or caretakers of a dependent child under 1 year of age.

* Parents or caretakers that provide care for a dependent child with a serious medical condition or disability, to be defined by DHHS.

* Individuals who are receiving unemployment compensation and complying with the work requirements that are part of the federal-State unemployment compensation system.

* Presumptively eligible Medicaid recipients, during the period of presumptive eligibility.

* Medicaid recipients who participate in the state Health Insurance Premium Payment program.

* Inmates of prisons.

Senate Republican leaders are making good on their pledge to fast-track a multilayered health care reform bill highlighted by plans to expand the state's Medicaid program.

House Bill 149 cleared the Senate Health Care and Finance committees Thursday unanimously - just more than a day after the amended bill was unveiled by Senate leader Phil Berger, R-Rockingham, and Sen. Joyce Krawiec, R-Forsyth.

The bill advanced to Senate Rules and Operations, which it ls likely to be heard early next week.

Medicaid currently covers 2.71 million North Carolinians, which increased by nearly 27% or 588,611 people since the pandemic surfaced, according to the N.C. Department of Health and Human Services.

Those who might be eligible under the expanded program are those between the ages of 18 and 64 who earn too much to qualify for Medicaid coverage, but not enough to purchase coverage on the private insurance marketplace.

It is likely, the Associated Press reported, that many of those new enrollees could remain on Medicaid post-pandemic if the proposed expansion bill becomes law.

As Senate GOP leadership has changed dramatically its viewpoint on Medicaid expansion because of the inclusion in HB149 of several Republican healthcare reform priorities, House GOP leaders have become lukewarm about Medicaid expansion.

So much so that House GOP leaders have indicated this week there is little expectation of taking up HB149 in its chamber by the time the short session ends, which is expected around early July.

Monkey wrench?

After HB149 was presented in Health Care in a discussion-only mode Wednesday, committee members had no questions Thursday before making a favorable recommendation.

The few Finance committee questions centered on whether a controversial work-requirement provision in the bill could play a monkey-wrench role in disqualifying access to funding from the 2021 federal COVID-19 relief law.

The work requirement for new Medicaid recipients has received grudging support from some Democratic legislators.

The federal relief law would provide North Carolina $1.5 billion over two years to treat traditional Medicaid patients if it accepts expansion, and most pivotally, agrees to not put stipulations on enrollees.

Legislative fiscal research analysis staff told Finance members they did not believe North Carolina would be eligible if HB149 contains the work requirement provision.

"In order to qualify ... you can't exclude anybody who would be part of the expansion population," legislative research analysis staff member Mark Collins told the committee.

"With work requirements, there's of course the possibility that somebody could be excluded."

That evaluation apparently was news to Krawiec, who said during Wednesday's unveiling of HB149 that "we're not likely to get a better deal (from the federal government) than is being offered now."

Krawiec said Thursday that in her discussions with state Health Secretary Kody Kinsley "he did not mention that we may not be qualified. So, that's an interesting note."

Sen. Paul Newton, R-Cabarrus, and Finance co-chairman, responded to questions about the federal relief funding by saying that "there's gray area there as to whether we would be eligible or not. It's TBD (to be determined), but it's a fair current reading of the (federal relief act)."

A work requirement passed by the Arkansas and New Hampshire legislatures has been struck down by federal courts. In March 2021, the U.S. Supreme Court said it would not hear additional arguments on the appeals made by the two states.

Berger said Wednesday the plan is to pass the bill with the work requirement included, "and then we'll deal with whether or not we can convince the Biden administration or the courts that this is the right thing to do."

Berger said that, while the work requirement is being litigated, enrollees would remain eligible and not be denied.

New reality

Berger and Krawiec said Wednesday that most GOP Senate leaders have embraced "a new reality" about Medicaid expansion in advocating for HB149.

"Medicaid expansion has now evolved to the point that it is good state fiscal policy and helps us address the mental health crisis we're facing," Berger said.

Their support, however, hinges on a give-and-take legislative proposal - that Democratic Gov. Roy Cooper and Democratic leaders are willing to accept several long-term GOP health care reform plans in order to expand Medicaid coverage.

Those include easing restrictions that could allow more health care providers, including for-profits, to enter the state's marketplace.

Cooper's office said the progress on Medicaid expansion is encouraging and that the governor "will carefully review this legislation."

Berger said recent Medicaid reform legislation, highlighted by the managed care transition that began in July, has made the state's system "capable of handling the additional (450,000 to 650,000) people who will be covered without creating problems for the state budget."

"It was a broken program that was mismanaged and burdened taxpayers with billion-dollar shortfalls on a regular basis," Berger said.

"Fortunately, over the past decade, Republican leadership in the General Assembly has turned Medicaid around in N.C. with eight straight years of solid Medicaid budgets without cost overruns."

GOP bill priorities

Berger emphasized that Senate GOP leaders believe Medicaid expansion "needs to happen with additional reforms, including the very real supply-side issues that prevent North Carolinians from accessing care."

Perhaps foremost is easing some restrictions on certificates of need, which health care providers must obtain from the state before building new health care centers or adding certain equipment.

Easing that restriction could allow for more competition, including from for-profit groups, for medical procedures.

The state's not-for-profit health care systems have opposed weakening certificate-of-need laws out of concern that large for-profit groups would enter North Carolina and cherry-pick the more lucrative services, leaving the not-for-profits treating the sickest patients, likely without health insurance, who come into emergency departments.

Other key elements of the proposed Medicaid expansion: permitting nurse practitioners, certified nurse midwives and nurses with other advanced specialties to practice without a physician's formal supervision; requiring health insurers in the state to cover telehealth services; and requiring in-network health facilities to alert consumers when out-of-network providers are scheduled to provide care.

Krawiec said the proposed bill "pairs with many other policy changes that will improve access to care," emphasizing reforming the certificate-of-need laws "that I have been working on since I got here."

Berger said that "we must do something to improve health care, especially expand access and control costs. We need coverage in North Carolina for the working poor."

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