Medicaid expansion heading to Gov Cooper for approval

On Wednesday, the North Carolina House voted to approve concurrence of H.B. 76, a bill to expand Medicaid, by a vote of 94-22.

The House will need to vote one more time on the bill before it officially goes to Gov. Roy Cooper’s desk for his signature. The final vote will occur Thursday, according to House Speaker Tim Moore’s chief of staff.

Donny Lambeth, R-Forsyth, spoke in support of H.B. 76 on the floor and urged his colleagues to vote in favor.

Cooper has been a longtime proponent of Medicaid expansion and issued a mostly supportive statement when legislative leaders announced the deal, although he said he wanted expansion implemented immediately.

At the time, Cooper said he looked “forward to reviewing the details of the bill.”

Cooper is expected to sign the bill quickly. However, the component of H.B. 76 that expands Medicaid will not go into effect until lawmakers reach an agreement on the state budget for the 2023-24 fiscal year.

The following will go into effect as soon as Cooper signs the bill:

• Increased Medicaid reimbursements provided to hospitals through the Healthcare Access and Stabilization Program (HASP)
• Increased hospital assessments to provide funding for the NC Health Works coverage and the HASP program at the start of the next fiscal quarter
• Repeal Certificate of Need (CON) review for the following: psychiatric beds and facilities; chemical dependency treatment beds and facilities; replacement equipment up to $3 million, indexed to inflation; an aggregate total of $3 million diagnostic center equipment that individually exceeds $10,000; early and periodic screening, diagnosis, and treatment services to children under age 21 at home health agencies

These parts of the bill will go into effect once the budget is approved:

• Medicaid coverage for adults aged 18-64 with incomes up to 133% of the federal poverty level, going into effect once the Centers for Medicare and Medicaid Services (CMS) approve the start date
• Workforce development measures promoting employment among Medicaid enrollees

Two years after the first HASP payment is made, ambulatory surgical centers will be removed from CON review if those centers meet certain requirements.

Three years after the first HASP payment is made, MRI machines in counties with a population in excess of 125,000 would be removed from CON review.

The SAVE Act, which would remove barriers for nurses to practice in North Carolina, is not included in the bill.

“We have a unique opportunity to expand coverage with federal funds already on the table,” said Speaker Tim Moore, R-Cleveland, a proponent of the bill. “The stakes are high, and the cost to the state is minimal.”

Opponents of the bill argue that this bill doesn’t go far enough to address supply-side problems.

“This course reversal on Medicaid expansion is hugely disappointing,” said Donald Bryson, president of the John Locke Foundation. “[The legislature’s] failure to meaningfully address supply-side problems will only exacerbate the statewide healthcare shortage and drive up wait times and costs for the general public.”

House Bill 76 previously passed the Senate 44-2.

Senate Leader Phil Berger, R-Rockingham, wrote an op-ed in the Carolina Journal in support of this Medicaid expansion bill. Rep. Ben Moss, R-Moore, wrote an op-ed in opposition to expansion.

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