North Carolina legislators approve Medicaid expansion

A deal between Republican majority leaders in the North Carolina General Assembly will fast-track a Medicaid expansion bill that local representatives say will help many underinsured people in rural North Carolina.

"This is a momentous agreement that will directly improve the health and well-being of 600, 000 North Carohnians," the North Carolina Department of Health and Human Services stated on Thursday, March 2. "We applaud the efforts by the General Assembly to move this forward. Medicaid expansion will be transformative for access to health care in rural areas, for better mental health and for veterans, working adults and their famihes. For these people, today's agreement is life changing." Sen. Kevin Corbin, a Franklin-based Republican who has been a proponent of Medicaid expansion for years in both the House and Senate, said he was part of the discussions the last several weeks between the N.C. Senate and House leaders.

"It was kind of a slow-go, there wasn't overwhelming support for it at the time, it's kind of grown and folks have come to realize it makes sense," Corbin said.

Medicaid expansion would help cover people who make higher than the federal poverty level but still can't afford health insurance.

Medicaid expansion is a federal program offered through the Affordable Care Act. The costs are 90% covered by federal dollars, mandated by the Affordable Care Act. The other 10% is the responsibility of the state. According to HB76, the state's 10% will be paid through federal hospital reimbursements.

"Basically, the taxpayers of North Carolina are not having to pay anything for this. It's a great benefit to the state, it's a great benefit for us economi- cally," Corbin said. "Especially for rural North Carolina, it's going to mean a lot, and that means a lot to me."

The work SO far

The N.C. Senate passed its own version of Medicaid expansion in 2022, but the N.C. House did not take it up, opting to wait until 2023 and the new legislative session. The N.C. House passed a version of Medicaid expansion, House Bill 76, on Feb. 15, with overwhelming bipartisan support.

Corbin said six of his eight counties have given him letters of support for moving forward with Medicaid expansion. The Franklin Town Council approved a resolution in support of Medicaid expansion at its March 6 meeting.

Corbin said the N.C. Senate will take up HB76, adding an amendment to reflect the compromise, then bring it to the floor for a vote this week. Part of the reason for the fast-tracking, Corbin said, is to get North Carolina onto the federal Medicare and Medicaid services funding program known as HASP (Healthcare Access and Stabilization Program).

"Angel Medical Center is one of those, that they get several million dollars," Corbin said. "We sign onto Medicaid, that's kind of a signing bonus for the hospitals, because the hospitals that serve Medicaid patients get a back pay actually all the way to July of last year, if we do that before July 1 this year."

According to media reports, North Carolina will also get a $1.8 billion signing bonus as stipulated in the 2021 federal stimulus package, for singing up for Medicaid expansion.

Another reason for the hurry, Corbin said, is that there are people on Medicaid due to the pandemic that will be coming off on Jan. 1, 2024, that would be eligible to go back on Medicaid with the expansion.

The amendment will need a concurrent vote in the N.C. House before going to Gov. Roy Cooper for final approval.

Cooper, a longtime proponent of Medicaid expansion who was not part of the legislative negotiations, said he is looking forward to reviewing the details of the bill once it passes the NCGA "An agreement by legislative leaders to expand Medicaid in North Carolina is a monumental step that will save lives and I commend the hard work that got us here," Cooper said on March 2. "Since we all agree this is the right thing to do, we should make it effective now to make sure we leverage the money that will save our rural hospitals and invest in mental health. I look forward to reviewing the details of the bill."

One of the previous points concerned reducing health care facility regulations known as Certificate of Need with the Senate aiming to reduce those regulations and the House not including it.

Corbin said the compromise adds a number of provisions for Certificate of Need. "Which we think will be good for rural North Carolina," he said.

Another compromise Corbin mentioned is the SAVE Act, which would allow advanced practice registered nurses to practice without doctor supervision in four roles: nurse practitioner, certified nurse midwife, clinical nurse specialist or certified registered nurse anesthetist. The Senate version last year included the act, but the House version and the compromise dropped it, leaving that for a separate bill.

North Carolina is one of 10 remaining states that has not signed on to Medicaid expansion. State Republican leaders had opposed it for a myriad of reasons, some saying it's because of provisions allowing able-bodied people to use it, others because of a lack of work requirements (which have been struck down in court in other states that tried to add them) and some because of fears that states would be on the hook for the costs if it was repealed by Congress.