NEW HANOVER COUNTY — The North Carolina General Assembly has passed an expansion to Medicaid after years of refusing to do so.
House Bill 76, which would cover an additional 600,000 North Carolinians and bring in billions of dollars, was passed by the House on Thursday morning in a 87-24 vote. Pender County’s Rep. Carson Smith joined his party members in the dissenting votes, all Republican. The legislation passed the Senate last week 44-2; all Cape Fear senators approved the measure.
The bill will now go before Gov. Roy Cooper, who has pushed for the expansion in the past and had indicated his support for H.B. 76.
“Medicaid Expansion is a once in a generation investment that will make all North Carolina families healthier while strengthening our economy, and I look forward to signing this legislation soon,” Cooper said in a statement.
The bill removes North Carolina from the list of 11 states yet to expand the federal program following the adoption of the Affordable Care Act 13 years ago.
However, state Republicans pushed for the Medicaid portion of the bill to delay going into effect until the legislature passes its budget, while other components will be immediate.
The expansion is aimed at closing the “Medicaid gap” which includes hundreds of thousands of low-income North Carolinians that can’t afford health coverage because they earn too much to qualify for the program as it is currently structured. The program, as is, mostly provides for children from families with low incomes, some of their parents, people with disabilities and seniors with limited financial means.
Critics of the bill say the expansion will lead to a surge in demand and wait times for services, increase state taxes and inflation, and drive up expenditures on Medicaid.
According to the bill, the federal government will pay 90% of Medicaid costs while the state will over the remaining 10%. However, it stipulates individuals’s coverage under the expansion will be discontinued if the federal percentage falls below 90%.
Estimates for the North Carolina portion of the coverage range from $224 million in the first year to about $700 million by the fourth year.
A Covid-19 recovery outlines North Carolina will also get an estimated extra $1.75 billion in cash over two years for expanding Medicaid, which lawmakers have said they plan to use on mental health services.
What makes this bill different than past attempts at expanding Medicaid is the lack of a work requirement for new program beneficiaries. However, a provision calls for the creation of NC Health Works, a program modeled on Montana geared at connecting the new Medicaid recipients that are unemployed with job opportunities. In Montana, 72% of participants got a job after training.
Another section of H.B. 76 would up federal payments for hospitals using the Healthcare Access and Stabilization Program, administered by the Centers for Medicare and Medicaid Services. State health officials say the program would bump up reimbursement for hospitals across the state by about $3 billion per year, but in exchange for North Carolina enacting the program, hospitals would foot the bill for the extra beneficiaries.
The bill’s primary sponsor, Rep. Donny Lambeth (R-Forsyth), said on the House floor the state will realize $1.7 billion annually from the federal subsidies and another $14 billion in the next five years for HASP.
Many health care organizations have supported the expansion, including the North Carolina Healthcare Association and North Carolina Medical Society.
“This is the kind of day we work for!” NCMS CEO Chip Baggett wrote in a press release. “Our team, our members, our partners, and people from across the state have long hoped for this bill to be signed. The bi-partisan support it received is a clear sign that lawmakers in North Carolina see access to healthcare as part of a strong citizenry.”
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