RALEIGH, N.C. (WGHP) – Medicaid expansion in North Carolina, long a goal for both the Democrats and the public at large, is down to its last steps before becoming law.

The Senate’s compromise version of House Bill 76 sailed through its second reading, 43-2, on Tuesday and has one more perfunctory passing to go before it heads back to the House for its final review, which could happen this week.

Then it would be off to the desk of an elated Gov. Roy Cooper for a final pen. The measure would become law immediately in some cases, but the full expansion of Medicaid will occur with the passage of a biennial budget.

State Sen. Joyce Krawiec (R-Kernersville)

State Sen. Joyce Krawiec (R-Kernersville) presented the bill for its second vote. She is a co-chair of the Senate Health Committee and a new advocate for the expansion as an opportunity to help rural hospitals.

“We have been talking about this for a long time,” Krawiec said during the final debate. “Actually we have been talking about this long before many of us arrived here in Senate.

“Many of us were opposed for a very long time. I was one of those. We were dealing with a broken Medicaid cycle in North Carolina. Every cycle we were plugging holes. We had to fix that before going into expanding Medicaid.”

She cited nine years of balanced budgets, underscored the negotiated aspects of the bill, and called it a “lifeline for rural hospitals” and the inclusion of a work requirement that could become a federally accepted pilot program.

“Thank you for this day coming around,” state Sen. Gladys Robinson (D-Greensboro) said. “Little late, but we’ll take it. Sen. Krawiec, I want to say thank you for understanding finally who this impacts … the working poor. They go to work but don’t make enough for health care. We appreciate your support.”

Senate Leader Berger (left) and House Speaker Tim Moore announce a deal on Medicaid expansion. Rep. Donny Lambeth is behind them.

State Rep. Donny Lambeth (R-Winston-Salem) was one of the architects of the bill.

“It is a good compromise and certainly moves NC forward to vastly improve health care in NC,” Lambeth told WGHP last week.

Last week, in his State of the State address to lawmakers, Cooper celebrated lawmakers’ agreement to expand Medicaid in North Carolina and implored them to go ahead and do the deal now and wait no longer.

North Carolina Gov. Roy Cooper waves as he leaves the House chamber after delivering his State of the State address to a joint session of the N.C. General Assembly on Monday. (Travis Long/The News & Observer via AP)

Cooper long has been an advocate for the state to cease its rejection of the billions of dollars from the federal government allotted in 2010 under the Affordable Care Act and offer expanded medical coverage to 600,000 or so residents who could be without it.

“Do it now,” Cooper implored the assembled lawmakers. “Don’t wait. No business would make such a decision.”

Budget progress

In their announcement of the agreement, Sen. Leader Phil Berger (R-Eden) and House Speaker Tim Moore (R-Cleveland) had predicted Cooper’s response but were adamant that expansion be tied to the budget’s passage, calling it a “budgetary matter.”

The amended bill does allow local hospitals to seek reimbursement through the federal Healthcare Access and Stabilization Program (or HASP) as soon as the bill becomes law, which provides facilities that are struggling in rural areas to have a new influx of dollars without delay.

Berger and Moore announced last week that they had agreed on the first aspects of their 2-year budget: a 6.5% increase for 2023 and 3.75% for 2024.

“Reaching this agreement with the Senate on the overall spend is an encouraging start to crafting another responsible budget that addresses the needs of North Carolinians, including key investments in teacher and state employee raises, infrastructure, and workforce development,” said Moore, who has promised to deliver his spending plan to the Senate by Easter, which is April 9.

But there is a deadline before then. Employees of the North Carolina Department of Health and Human Services will begin on April 1 a recertification of benefits that could lead – and emphasis on “could” – to 300,000 people being removed from medical coverage because a national law covering them expires.

These are people who were receiving coverage through the first Coronavirus Response Act under a stipulation that states keep all Medicaid-eligible residents covered, regardless of whether that state had expanded Medicaid under provisions of the Affordable Care Act.

The compromise bill

HB 76 was orchestrated by Lambeth, a retired hospital administrator, who called it a stripped-down version of the broader expansion the Senate passed last summer with Senate Bill 408which included various concepts to senators believed would provide greater access to healthcare in rural counties. That bill passed the Senate with near-unanimous support but never gained traction in the House.

State Sen. Ralph Hise (R-Spruce Pine), another longtime advocate of expanding Medicaid, shepherded the amendments through the Senate. The stipulations added include:

  • The elimination of a certificate of need for:
    • Behavioral health beds.
    • Chemical dependence beds.
    • Raise replacement equipment threshold to $3 million and index to inflation.
    • Increase threshold for diagnostic centers to $3 million and index to inflation.
    • MRI machines in counties with a population above 125,000 effective three years from first HASP payment.
    • Ambulatory surgery centers in counties with a population above 125,000, effective two years from first HASP payment for multispecialty and single specialty.
      • 4% charity care requirement for ambulatory surgery centers (in counties with population above 125,000).
      • Annual reporting requirement regarding charity care.
  • HASP would become effective immediately.
  • Medicaid expansion would be effective only upon passage of the 2023 budget.

A joint effort

Moore said last week that legislators “consulted with stakeholders … hospitals … healthcare providers … you name it … to get varying points of view. We came up with something that I believe is very carefully crafted and an appropriate balance for where we are in North Carolina.”

North Carolina Medical Society CEO Chip Baggett said last week that this compromise bill “represents a true commitment to the people of North Carolina and their health. It is legislation the NCMS has long considered of utmost importance, and we thank everyone who has helped move it forward.”

Krawiec, who with Berger had pushed the expansion last summer in a dramatic reversal from their earlier opposition, said in an email that she is “delighted that Medicaid expansion will become a reality in North Carolina. Many of our hard-working families will now be able to receive the health care they need, without any cost to the state.”