Medicaid expansion bill would extend coverage to 500K

RALEIGH — Bipartisan legislation introduced in the North Carolina House on Thursday marks the first proposal to expand Medicaid in the 2023 session, a move that would be funded by the federal government and assessments on hospitals.

Republican state Reps. Donny Lambeth of Forsyth County, Donna McDowell White of Johnston County, and Chris Humphrey of Lenoir County, joined with Democratic Rep. Michael Wray of Northampton County to introduce House Bill 76, titled "Access to Healthcare Options."

It was slated for a 10 a.m. Tuesday hearing in the House Committee on Health.

HB76 would expand Medicaid coverage to those eligible for Alternative Benefit Plans through changes in the federal Affordable Care Act, coverage referred to as "NC Health Works." The coverage would include about 500,000 working North Carolinians who cannot afford health insurance.

HB76 states "it is the intent of the General Assembly to fully fund the nonfederal share of the cost of NC Health Works through a combination of … sources."

Those sources include a gross premium tax, increases in intergovernmental transfers, "hospital health advancement assessments," and savings through General Fund budget reductions to other state programs.

"If, for any fiscal year, the nonfederal share of the cost of NC Health Works cannot be fully funded through the sources described … then Medicaid coverage (for those in NC Health Works) shall be discontinued as expeditiously as possible," the bill reads.

The legislation would task the North Carolina Department of Health and Human Services with reporting to the General Assembly, Office of State Budget and Management, and Fiscal Research Division specific cost information, including total nonfederal share of the cost of NC Health Works, projected funding available, health advancement assessment proceeds, and saving and benefits for NC Health Works.

HB76 would also require lawmakers to discontinue NC Health Works "as expeditiously as possible" if the federal share of coverage falls below 90%, and lays out the process to do that. State officials have said North Carolina could receive $1.8 billion from the federal government to make the transition.

North Carolina is among a dozen states that have not expanded Medicaid under the Affordable Care Act. Republicans in the General Assembly, with majorities since 2010, have long resisted the change due to costs; Democratic Gov. Roy Cooper has championed it since taking office in January 2017. Other states that have not expanded include Wyoming, Wisconsin, Kansas, Texas, and the southeast's Tennessee, Mississippi, Alabama, Georgia, South Carolina and Florida.

The dynamic in North Carolina changed last session, when Senate Republicans approved expansion along with other reforms designed to improve access to health care. The measure did not clear the House, which opted instead to study the issue further. HB76 does not include the additional reforms in last year's Senate bill, which would have curtailed the state's certificate of need laws and expanded the scope of practice for certain nurses.

Both House Speaker Tim Moore, R-Cleveland, and Senate Leader Phil Berger, R-Rockingham, have signaled Medicaid expansion is a priority in the 2023 session, though their position on HB76 is unclear.

Lambeth, HB76's lead sponsor, is a retired health care executive and long-time proponent of Medicaid expansion. Wray, the primary Democrat sponsoring the bill, is one of three from the minority party named by the majority to co-chair key committees this session.

Other Republican sponsors include Reps. William Brisson of Bladen County, John Faircloth of Guilford County, Howard Penny Jr. of Harnett County, Stephen Ross of Alamance County, Wayne Sasser of Stanly County, and Matthew Winslow of Granville County.

Democratic sponsors include Reps. Marvin Lucas of Cumberland County and Garland Pierce of Hoke County. Lucas has been in the House since 2001; Pierce has been on Jones Street since 2005, is an Army veteran and a Baptist minister. Both are Fayetteville State undergrads.

As many as 375,000 North Carolinians could lose Medicaid coverage when the federal government ends a continuous coverage requirement from the pandemic that prevented states from removing those who do not quality.

The April 1 transition will require the North Carolina DHHS to requalify Medicaid beneficiaries for coverage over the following year, as the federal government phases out enhanced funding for the continuous coverage.