North Carolina budget standoff continues over Medicaid expansion

News & Observer (Raleigh, NC)

Jul. 16--RALEIGH -- Updated July 16, 2019, with new developments.

Despite pressure from both Republicans and Democrats, North Carolina's budget standoff continues more than two weeks into the new fiscal year.

The state budget is stalled out over Medicaid expansion. It's been a week since Republicans offered a Medicaid expansion compromise bill hoping to get more Democrats on board. But the state House has yet to approve the bill or override Democratic Gov. Roy Cooper's veto.

Unlike the federal government, the budget impasse won't lead to a shutdown. But the pressure is still on to pass the budget so state employees can get raises and projects can move forward.

Both were on the calendar for Monday night's House session, but House Speaker Tim Moore didn't call for a vote, and it will remain on the calendar for another day.

Meanwhile, a bill allowing the state to keep accepting federal funding in the form of block grants moved forward in a Senate committee Tuesday morning. The Senate will vote on it next week, Senate Majority Leader Harry Brown said during a press conference Tuesday with Senate leader Phil Berger.

Medicaid expansion

Berger said that when he last spoke with Cooper "it was clear that there was nothing that could be done as far as budget negotiations moving forward unless there was an agreement that Medicaid expansion was either part of the budget, or passed in advance of the budget."

Cooper and Democrats want full Medicaid expansion. The Republican-led House and Senate did not include Medicaid expansion in their own budgets nor their conference budget, which Cooper vetoed June 28. So Republicans came up with what they called "a type of Medicaid expansion" last week, rushed it through committee and sent it to the House floor.

It had bipartisan support in the House committee, but critics, too. House Bill 655, called NC Health Care for Working Families, awaits House approval, along with 12 proposed amendments. So does taking a vote on overriding Cooper's budget veto.

While the House has a Republican majority, Republicans don't have the supermajority needed to override a Cooper veto. They need every Republican to vote and at least seven Democrats to pass for an override.

Moore, a Kings Mountain Republican, said last week that he would keep putting the override vote on the House calendar until a vote, but did not say when that vote would be taken. House members have debated parliamentary procedure about when to take a vote, and whether it could be called while a member has stepped out of chambers.

House Democratic Leader Darren Jackson said last week on the House floor that they should know when the override vote would be taken so Democrats could take restroom breaks or leave the room without worrying about a vote being called when they were absent. But the House decided it was up to Moore to choose the order of the session votes.

Berger said Tuesday what the speaker is doing is consistent with House rules.

"It's been that way for a long time," Berger said. "Some folks might complain about it but it's not anything new."

Budget vote pressure

The Fayetteville Observer reported that Cooper visited multiple churches on Sunday, urging congregants to ask their Democratic representatives to hold fast and sustain Cooper's veto. The newspaper reported that the governor was invited to the city by Democratic Mayor Mitch Colvin, and that Rep. Billy Richardson, also a Democrat, was wrestling with how to vote on the budget, which includes $132 million in earmarks for Fayetteville.

Republicans have been criticizing Cooper for holding up the budget over Medicaid, listing various things the budget would provide if passed.

Brown called it a "Medicaid-or-nothing ultimatum."

"The budget that the Governor vetoed over his Medicaid-or-nothing ultimatum would have rectified years of inequitable treatment for state employees and provided much-needed research and capital funds for the UNC system," Brown said in a statement on Monday, going on to list other budget items, including raises for prison system employees and university capital improvements.

Medicaid compromise bill

When the House bill was discussed in committee last week, Rep. Donny Lambeth, a Winston-Salem Republican, called it an alternative option that "might fit North Carolina's culture."

Lambeth said it would serve 300,000 North Carolinians who currently have no health insurance, and up to 500,000 total if everyone eligible uses it. The work requirement is a key difference between this and Cooper's Medicaid expansion. Participants' costs would be 2% of their household income, billed monthly. It would cover those residents who meet all federal Medicaid citizenship and immigration requirements and are not eligible for Medicaid under the current program.

Other requirements include: their modified adjusted gross income is not higher than 133% of the federal poverty level; they are not entitled to or enrolled in Medicare Part A or B; and they are between the ages of 19 and 64.

Cooper's Medicaid expansion does not include work requirements or premiums. Cooper has been holding Medicaid expansion roundtables with those who would benefit from full Medicaid expansion.

Medicaid transformation

Meanwhile, North Carolinians who use Medicaid in 27 counties can start enrolling in the transition from fee-for-service to managed care. The change comes to the Department of Health and Human Services after legislation in 2015, called "Medicaid transformation" by legislators this session. The state will now contract with insurance companies, which are paid a predetermined rate per person, according to DHHS.

Open enrollment continues through Sept. 13 for Alamance, Alleghany, Ashe, Caswell, Chatham, Durham, Davidson, Davie, Forsyth, Franklin, Granville, Guilford, Johnston, Nash, Orange, Person, Randolph, Rockingham, Stokes, Surry, Vance, Wake, Warren, Watauga, Wilkes, Wilson and Yadkin counties. Packets were mailed home to 300,000 households in those counties, according to DHHS, for patients to choose a plan and primary care provider. That coverage will begin Nov. 1.