Bill passed to expand Medicaid in North Carolina

After fighting for years to expand Medicaid in North Carolina, the Republican-led state General Assembly moved the policy in a bipartisan vote Wednesday.

North Carolina hospitals have supported the expansion of Medicaid since the Affordable Care Act went into effect in 2010 with generous federal funding to expand eligibility for the program. As in other states, the hospital industry sees the expansion of Medicaid as a means to expand health care coverage, reduce unpaid care, and strengthen finances in struggling facilities, especially in rural areas.

The bill, which passed the House 94-22 on Wednesday after being approved 44-2 by the Senate last week, won the support of all Democrats in the General Assembly and nearly all Republicans. The House of Representatives is due to hold a final confirmation vote on Thursday to complete the legislative process.

Governor Roy Cooper (D) is expected to sign the measure.

The legislation includes new hospital valuations to fund the government’s share of expansion costs. The hospitals are projected to contribute $550 million a year. The bill would also have loosened the needs certificate laws. The North Carolina Health Association, which represents the hospitals, supported the proposal.

An estimated 600,000 adults in North Carolina with incomes below 133% of the federal poverty level — $19,391 per year per person — will be eligible when the law goes into effect.

Under the Affordable Care Act, the federal government funds 90% of the cost of expanding Medicaid, with states responsible for the remainder. In addition, President Joe Biden passed legislation last year to provide additional short-term funding to states that are taking action to expand Medicaid.

When Congress passed the ACA, the Medicaid expansion was supposed to go national, but in 2012 the Supreme Court ruled that states could opt out. Apart from North Carolina, 10 states have not extended Medicaid under the ACA.

Objections to Obamacare support and financial problems have thwarted previous efforts to expand Medicaid in North Carolina.

The state legislature came close last year when the House and Senate passed bills to expand Medicaid. But the Houses failed to come to a consensus until the adjournment of the General Assembly in July. North Carolina House Speaker Tim Moore (right) and Pro Tempore Senate Chairman Phil Berger (right) broke the deadlock by announcing a bicameral agreement on March 2.

Even if Cooper passes legislation, he and the legislature still have one more hurdle to overcome before Medicaid expansion becomes a reality in North Carolina. Lawmakers should include the financial aspects of the expansion policy in the overall budget bill, which could provoke disagreements between GOP lawmakers and the Democratic governor on unrelated issues.