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After 7 years, Medicaid expansion in sight for North Carolina

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North Carolina might see its own expansion of Medicaid as former Republican opponents indicate newfound support for the proposal.

After being only one of 12 states in the US not to expand Medicaid since the Affordable Care Act Medicaid expansion in 2014, the North Carolina Healthcare Association has made a proposal that may finally get the ball rolling in the state.

On Sept. 16, the NCHA sent a detailed proposal to Gov. Roy Cooper, Senate President Pro Tempore Phil Berger and House Speaker Tim Moore, which addressed previous barriers that had impeded NC representatives from getting on board with Medicaid expansions.

Berger and Cooper had previously insisted that Medicaid expansions be coupled with certificate of need reforms. Certificates of need are legal documents required for healthcare facility expansions.

If implemented, the certificate of need reforms could result in the loss of $700 million in revenue for outpatient surgical centers. The increased expenses “would be harmful to hospitals and erode the state’s safety net” as hospitals already operate on thin margins, NCHA spokesperson Cynthia Charles wrote in an email to US News.

But after months of deliberation and calls for reform by representatives and residents, the NCHA stated that it would back legal changes regarding ambulatory surgery centers and the repeal of certificate of need requirements for new inpatient beds meant for patients with psychiatric and chemical dependency issues. The proposal also stated that the hospitals would fund approximately $550 million worth of expenses for Medicaid expansion in North Carolina.

Although Republican representatives have been a source of pushback against North Carolina health policy reform, many have now joined in on the fight for Medicaid expansion.

Berger, who in 2017 with Moore filed a federal lawsuit against Cooper for attempting to expand Medicaid without legislative approval, has indicated that he supports the expansion because of his sympathies for the poor working parents in North Carolina who don’t qualify for Medicaid.

Moore spoke to the matter as well, commenting that he believes expanded Medicaid to be good state fiscal policy that will bring NC taxpayer money back to the state.

“Instead of the feds or anyone else just creating something and sending it here, this is something we have the opportunity, from start to finish, to make sure it makes sense for North Carolinians,” Moore told The News & Observer.

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38 out of 50 states have expanded Medicaid eligibility for those with incomes up to 133% of the poverty level, ever since the Affordable Care Act Medicaid expansion took place Jan. 1, 2014. However, due to a 2012 Supreme Court ruling, states could not be penalized for not expanding Medicaid. Hundreds of thousands of North Carolina residents fall in a gray area where many cannot pay for private insurance but are not eligible for the state’s unexpanded Medicaid plan.

As a result, when Governor Roy Cooper took office in 2017, one of his first initiatives was to expand Medicaid. His first attempt came in the state budget proposal for State Fiscal Years 2020-2021, but because the North Carolina legislature was Republican-controlled, his ambitions were voted down.

The political climate began to change last summer when Republicans in the NC Senate passed a bill on June 2 that would expand Medicaid coverage to over 600,000 low-income NC residents. This bill would have led to expanded coverage implemented before July 1, 2023. Another bill of a similar nature was passed by the House on June 28 that would create a committee devoted to Medicaid expansion related decisions to take place in December. Neither of these bills advanced any further.

Debate continues between Berger and his allies, who want the Senate version of the bill to be implemented, and Moore and other House Republican leaders, who are seeking to revise the bill to exclude the health care policy reforms.

In a letter to Republican leaders of the General Assembly and hospital executives, Kody Kinsley, secretary of the NC Department of Health and Human Services, urged more quick-paced actions as even with a December decision, changes couldn’t be implemented until April 2023. According to Cooper, there is also a opportunity that the state could lose access to the year’s expansion money if decisions are not sped up.

“Passing legislation in September is likely our last chance to go live this calendar year,” Kinsley wrote.

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