The NC General Assembly has wrapped the scheduled October session, but tensions are still running high between the chambers over a Medicaid rebase stalemate and its increasing sticker shock.
The NC House passed several measures on Wednesday that the Senate refused to take into their chamber, accusing the other House of “playing politics” in sending “ineligible” bills across the legislature lobby.
On Wednesday, the House approved several health care-related bills, including two measures providing additional funding for the state’s Medicaid rebase and another prohibiting Medicaid funding for Planned Parenthood. Neither were the measure that the NC Senate called for the House to green-light in a press statement issued Wednesday afternoon.
“If the House is serious about providing much-needed pay increases for our hardworking men and women in law enforcement and putting an end to taxpayer dollars supporting Planned Parenthood, all they have to do is concur with House Bills 42 and 192,” Senate Appropriations Chairs Brent Jackson, R-Sampson; Ralph Hise, R-Mitchell; and Michael Lee, R-New Hanover, said in the statement. “It’s time to stop playing politics and come to the negotiating table.”
Instead, the House approved House Bill 491, Medicaid Rebase Adjustment, which appropriates $190 million in nonrecurring funds to support Medicaid operations. Senate Bill 405, was passed by the House separately by a unanimous vote and adds $90 million in recurring funds.
In addition, $600 million has already been allotted for the Medicaid rebase in HB 125, signed by Stein in August. According to reports $100 million of that would go toward managed care administrative costs, leaving only $500 million for the actual rebase. If SB 405 is eventually passed by the Senate, that increases the rebase amount to $690 million. If the Senate were to also pass HB 491, it would bring the total rebase amount to $880 million. That price tag would be even more than the $819 million NCDHHS had requested, and alarms economists
“A nearly $1 billion Medicaid rebase is deeply concerning,” said Joe Harris, fiscal policy analyst for the John Locke Foundation. “Even if the rebase itself does not fund Medicaid expansion, it’s clear that expansion is driving up the cost of coverage for traditional groups. At a 15 percent year-over-year increase, the state is on track to double Medicaid appropriations within five years — a trajectory that’s simply unsustainable for taxpayers.”
House lawmakers also noted that $310 million will remain in the Medicaid Contingency Reserve for potential additional needs later in the fiscal year.
In a rare public glimpse of the internal negotiations, Senate leadership’s press statement Wednesday said that earlier this week the Senate sent the House a proposal to include Back the Blue Act and H192, along with funding for the Medicaid rebase in the latest mini-budget, Senate Bill 449. The bill also included reduced proposed funding for the children’s hospital.
“The House would not agree to the proposal and ended negotiations,” the Senate statement read. Senate leadership went on to say that the additional bills that the House considered are “ineligible,” criticizing the other chamber for adjourning without an agreement.
Among them, House separately passed Senate Bill 378, “Align Medicaid Eligibility with Federal Law,” by a vote of 61 to 47, which prohibits Medicaid funding for Planned Parenthood. The legislation aligns state law with the recently enacted One Big Beautiful Bill, requiring North Carolina’s Medicaid program to remove Planned Parenthood as an approved provider.
The Senate also refused to take the Healthcare Investment Act, passed by the House Wednesday, which includes long-term provisions for Medicaid operations, such as $49.2 million in recurring and $34.4 million in nonrecurring funds to support managed care, $1 million for the state auditor to review county-level Medicaid eligibility redeterminations and DSS performance, and a directive requiring NCDHHS to develop a plan to improve cost savings and streamline operations.
House Speaker Destin Hall, R-Caldwell, said the new funding measures were intended to protect providers from rate cuts ordered earlier this month by Gov. Josh Stein.
“As of this week, the North Carolina House of Representatives has passed three clean, stand-alone bills to fund the state’s Medicaid rebase and protect patients from Governor Josh Stein’s unnecessary, politically-motivated rate cuts,” House leadership said in a statement out on Thursday. “State health officials confirm that any of the three proposals would lead the administration to drop their cuts. This repeated effort shows House healthcare leaders are ready to solve Stein’s manufactured crisis and won’t let procedural roadblocks stand in the way of delivering for North Carolinians.”
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