NC lawmakers reach awaited Medicaid expansion agreement
RALEIGH, N.C. — North Carolina legislative leaders announced Thursday an agreement to expand Medicaid to hundreds of thousands of additional low-income adults through the Affordable Care Act.
The deal, unlikely to be voted on until later this month, marks a milestone for Republican lawmakers, most of whom opposed expansion for a decade until recently, and for hospitals and patient advocates who sought it all that time.
North Carolina has been one of 11 states that has not adopted Medicaid expansion. If the deal goes through, the state would start providing expansion coverage in January.
“This is something that we can all be very proud of,” House Speaker Tim Moore said at a news conference with Senate leader Phil Berger. “What a huge announcement this is for North Carolina. What a huge policy direction this is that will provide help for so many in this state, but it’s going to do it in a way that’s fiscally responsible.”
Expansion gained momentum last year when the GOP-controlled state House and Senate approved, with strong bipartisan support, competing legislation addressing it — but they failed to reach a deal. The key differences stemmed around other initiatives Senate Republicans insisted were needed to increase the number of medical providers to cover the additional enrollees.
Under the agreement, senators obtained the loosening or elimination of “certificate of need” laws that require health regulators to sign off on plans to offer hospital beds for mental health and substance abuse patients, build ambulatory surgery centers or purchase MRI machines. But their demand that advanced-practice nurses be able to treat patients without a doctor’s supervision was left out.
“There are still some things that need to be done, but this is our agreement and I’m very comfortable with it,” Berger said.
The negotiated measure, built in part on an expansion measure approved overwhelmingly by the House two weeks ago, was still being drawn up Thursday and will need affirmative votes in both chambers.
The federal government covers 90% of the cost of Medicaid recipients under expansion. Potentially 600,000 people in North Carolina could receive the benefit — those who make too much to qualify for conventional Medicaid but not enough to receive heavily subsidized health insurance that President Barack Obama’s signature 2010 law provides.
Democratic Gov. Roy Cooper, who has sought expansion since taking office in 2017, tweeted that the agreement “is a monumental step that will save lives” but wants it effective immediately “to make sure we leverage the money that will save our rural hospitals and invest in mental health.”
The North Carolina Healthcare Association, representing hospitals and health systems, praised legislators for Thursday’s agreement. The group backs certificate of need laws but offered some ways to scale them back in negotiations last year.
“Expanding Medicaid will improve the health of our people, our economy and our entire health care system,” said Abby Emanuelson, executive director of Care4Carolina, a coalition of over 165 groups that has worked for expansion since 2014.