Medicaid expansion didn’t make the state budget. Is it still an option for NC?
North Carolina lawmakers spent years at loggerheads over Medicaid expansion. While Democratic legislators championed the Obama-era provision, Republicans rejected it.
That changed during this year’s legislative session. For the first time in nearly 10 years, both Republicans and Democrats agreed to pursue Medicaid expansion.
But in the end, they couldn’t reach an accord.
In the Republican-written state budget, which Democratic Gov. Roy Cooper signed into law Monday, Medicaid expansion is conspicuously absent. Why didn’t legislators expand Medicaid if there was bipartisan support? Is further discussion off the table? And what would Medicaid expansion mean for North Carolina residents?
The News & Observer has answers for you here.
What is Medicaid? And what would its expansion mean?
Medicaid is a health insurance program for low-income families. It’s managed at the state level, but partly funded by federal dollars.
Medicaid should not be confused with Medicare, a federally operated system reserved mostly for older Americans.
The Affordable Care Act of 2010 empowered state governments to increase Medicaid eligibility with federal funding. Before the ACA option for Medicaid expansion, most qualifying applicants had either a disability or minor children. In states with expanded Medicaid, almost all adults with incomes up to 138% of the federal poverty level can benefit from the public insurance provision.
So far, 38 states and Washington, D.C., have enacted Medicaid expansion programs.
If North Carolina expanded its Medicaid access, roughly half a million uninsured residents would qualify for coverage.
Is it still possible NC will expand Medicaid?
Yes.
Legislative leaders have committed to ongoing discussions of Medicaid expansion.
“The General Assembly passed the 2022 budget with strong bipartisan support, and we are pleased Gov. Cooper signed this responsible spending plan into law,” Senate leader Phil Berger and House Speaker Tim Moore, both Republicans, said in a statement Monday.
“Moving forward, we are committed to working together to improve healthcare access and expand Medicaid, while providing the necessary safeguards to preserve the state’s fiscal strength. Active negotiations are occurring now toward that end.”
But the General Assembly must act soon or else “jeopardize” some extra federal contributions, Moore has said. If the state does not expand Medicaid before the end of the year, it leaves a $1.5 billion bonus on the table.
The federal government will still pay 90% of costs, even without that bonus.
At the end of this year’s session, Moore suggested a Medicaid expansion plan might come together by December. Berger hasn’t indicated when he hopes to complete an expansion proposal.
For Democrats, widespread Republican interest in Medicaid expansion is a watershed.
“I am ecstatic that the House is actually considering doing something with Medicaid,” Rep. Robert Reives, the House Democratic leader, previously told The N&O. “And I think the important part is that no matter what happens with this bill, that means that now we have a full conversation going, and that is incredibly important.”
So why wasn’t it part of this year’s budget?
Legislators agree they want to expand Medicaid. They haven’t agreed on how.
For example, a Senate bill this session called for immediate Medicaid expansion. A proposal from the House suggested further study first.
While the Senate bill would have made massive changes to the state’s health care industry, the House opposed such sweeping reorganization.
Neither chamber could agree to a compromise in time for legislation to pass independently or as part of the larger state budget.
This story was originally published July 11, 2022 at 6:46 PM with the headline "Medicaid expansion didn’t make the state budget. Is it still an option for NC?."
