NC House sends Medicaid expansion bill to Senate

RALEIGH, N.C. — Legislation that would expand Medicaid coverage in North Carolina to hundreds of thousands of low-income adults through the 2010 Affordable Care Act advanced to the Senate with House approval Thursday.

A second day of strong bipartisan support for the legislation — the chamber gave initial approval to the measure Wednesday — affirms that approving expansion during this year’s legislative session is within reach.

North Carolina is among 11 states that haven’t adopted Medicaid expansion.

“This is a part of history and we need to move this forward so that we can have serious discussions with the Senate,” bill sponsor Rep. Donny Lambeth, a Forsyth County Republican, said before Thursday’s 92-22 vote. Two-thirds of House Republicans voting joined all Democrats present in backing the bill.

In the Senate, Republicans also back expansion but want it coupled with a series of initiatives to build out the supply of health care services and providers. Those include scaling back “certificate of need” laws that require regulatory hurdles before medical equipment is used or new hospital beds filled. Speaker Tim Moore said after Thursday’s vote that House members were willing to discuss certificate of need reforms with senators.

The two chambers passed competing expansion measures in 2022 but failed to reach a compromise.

This year’s House measure would begin expansion in January, provided that the General Assembly approves a state budget law this year.

The federal government covers 90% of expansion costs. The state’s 10% share of expenses for expansion enrollees would be paid through increased hospital assessments to the state. But the bill also envisions hospitals receiving billions of additional federal dollars to cover Medicaid patients.

The House bill tells state health officials to attempt to negotiate with federal health regulators to require some Medicaid enrollees to work in order to retain coverage.

Medicaid enrollment is 2.9 million in North Carolina. Expansion could cover as many as 600,000 people in the state, according to legislators and advocates. Some of these people obtained and retained Medicaid services during the COVID-19 emergency because eligibility verifications were suspended. Those verifications will resume soon, resulting over time in 300,000 beneficiaries losing full health care coverage, according to the state Department of Health and Human Services.