North Carolina Legislators Reach Agreement on Medicaid Expansion

Republican speaker of the North Carolina House of Representatives, Tim Moore, speaks to the press in front of the U.S. Supreme Court in Washington, DC, on Dec. 7, 2022. Olivier Douliery/AFP via Getty Images

North Carolina legislative leaders reached an agreement on March 2 to expand Medicaid to hundreds of thousands of additional low-income adults through the Affordable Care Act, also known as Obamacare.

The deal, which marks a milestone for Republican lawmakers—many of whom had until recently been opposed to the idea—will likely pass through North Carolina’s General Assembly, according to House Speaker Tim Moore and Senate leader Phil Berger.

North Carolina has been one of 11 states that have opted not to adopt Medicaid expansion. If the deal passes North Carolina’s General Assembly, the state would start providing expanded coverage to people starting in January 2024.

“This is something that we can all be very proud of,” Moore said at a Legislative Building news conference with 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.”

He added that the bill will “expand access to working North Carolinians” and will “ensure that there is a more robust supply of a lot of these services.”

What’s in the Deal

“That is going to result in less cost, but at the same time vitally important to protect access to health care, particularly in our rural areas,” Moore said.

The federal government covers 90 percent of the cost of Medicaid recipients under expansion and under the deal, known as House Bill 76: “Access to Healthcare Options,” the state’s 10 percent share would be paid for by using revenue from assessments paid by hospitals, which in turn benefit from getting reimbursed as they cover patients with Medicaid.

Individuals aged between 18 and 64 with incomes of up to 133 percent of the federal poverty level—which is around $19,391 for an individual or $33,064 for a family of three—will be eligible for Medicaid, which helps cover medical costs for those with limited income and resources, under the agreement.

The coverage would include preventive care and wellness.

Berger said the agreement will also “eliminate certificate of need for behavioral health beds, for chemical dependency beds. It will raise the replacement equipment threshold to $3 million and index that number to inflation. It will increase the threshold for diagnostic centers to $3 million and index that to inflation.”

According to the North Carolina Department of Health and Human Services (NCDHHS), the expansion would make 600,000 low-income North Carolinians eligible for the program and directly improve their health and well-being.

“We applaud the efforts by the General Assembly to move this forward,” NCDHHS said in a statement. “Medicaid expansion will be transformative for access to health care in rural areas, for better mental health, and for veterans, working adults, and their families. For these people, today’s agreement is life-changing.”

Medicaid a Sticking Point

NCDHHS added that the expansion, along with the Healthcare Access and Stabilization Program (HASP)—a federal program that allows states to direct funds to providers through managed care contracts—will bring in $8 billion to North Carolina every year with no additional cost to the state.

It will also bring in $1.8 billion which can support behavioral health, public safety support, rural health care, and other needs, according to the department.

“North Carolina can receive an additional $1.8 billion in HASP payments if we are able to implement both these programs this fiscal year,” NCDHHS said.

Medicaid has long been a sticking point between Republicans and Democrats in North Carolina and was part of the reason the General Assembly and Gov. Roy Cooper were unable to pass a new budget for the state in 2019.

Cooper, a Democrat, said on Twitter on Thursday that the agreement marks a “monumental step that will save lives.”

“I commend the hard work that got us here. 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,” Cooper said.

The Associated Press contributed to this report.