Will NC Republicans Finally Expand Medicaid After a Decade of Delays? A New Bill Could Pave the Way.

Rebecca Cerese, a policy advocate at the North Carolina Justice Center, speaks at a vigil in front of the North Carolina Legislative Building in Raleigh, N.C., Tuesday, July 26, 2022, to remember people lacking Medicaid coverage or insurance who have died. Cerese and other speakers urged lawmakers to pass a law so North Carolina accepts federal funds to expand Medicaid coverage to hundreds of thousands of additional adults (AP Photo/Gary D. Robertson)

By Keya Vakil

February 13, 2023

Medicaid expansion has been shown to save lives, reduce postpartum hospitalizations, improve access to mental health and substance use treatment, prevent more rural hospitals from closing in the state, and create tens of thousands of jobs in the state.

Will 600,000 North Carolina residents get low-cost health insurance this year? 

We may soon find out, as the North Carolina state House plans to hold hearings this week on a new bill to expand Medicaid health insurance to hundreds of thousands of low-income North Carolinians, including those with children at home.

The bill, introduced Wednesday by Republican state Rep. Donny Lambeth, would expand coverage as part of the Affordable Care Act’s opt-in expansion program. 

Thirty-nine states have expanded Medicaid under the Affordable Care Act, allowing them to offer coverage to nearly all adults with incomes up to 138% of the Federal Poverty Level ($18,755 for an individual in 2022), with the federal government covering 90% of the costs.

Under Republican leadership, North Carolina is one of 11 states that has failed to expand Medicaid. In 2022, the legislature came closer than it ever had to expanding Medicaid, passing two separate bills in the House and Senate. Ultimately though, Republican leaders failed to agree on a final bill.

Now they’re trying again. Under Lambeth’s bill, hospitals would pay the remaining 10%. Thanks to President Biden’s 2021 American Rescue Plan, the state would also receive a $1.5 billion payment from the federal government to treat traditional Medicaid patients if the legislature agrees to expand Medicaid.

Healthcare providers and patient advocates celebrated the introduction of the bill and called on lawmakers to pass the legislation this year, noting that it would profoundly benefit the state.

Medicaid expansion has been shown to save lives, with one study finding that Medicaid expansion led to nearly 12 fewer deaths per 100,000 adults each year in expansion states. Another recent study found that Medicaid expansion states also saw reduced rates of postpartum hospitalization. 

Expanding access to the program would also provide coverage for sorely-needed mental health and substance use treatment. In 2019, more than 55% of North Carolinians who needed treatment did not receive it because of the cost, according to the North Carolina Department of Health and Human Services. 

“If we can get more people on Medicaid, they would’ve access to a much wider array of behavioral health services,” Kelly Crosbie, director of the North Carolina Division of Mental Health Developmental Disabilities and Substance Use Services, told Cardinal & Pine in a recent interview. 

Expansion would also help address the state’s growing overdose crisis, as it would cover the cost of medication-assisted treatment which is considered the best way to treat addiction, but can be prohibitively expensive for many individuals.

“Medicaid Expansion is the easiest and most effective step our state can take to continue our fight against this deadly disease,” Democratic Gov. Roy Cooper has said in the past.

Attorney General Josh Stein, a fellow Democrat running to replace Cooper as governor in 2024, has also called on the legislature to expand Medicaid to help address the opioid crisis.

“Our state is failing to perform the single most important act it could to address the opioid problem,” he wrote in October. “We are leaving billions of our own dollars on the table as we’ve already paid these funds to the federal government. Let’s say yes so we can save lives…Please contact your state legislators with a simple ask: expand Medicaid and save lives.”


Expanding Medicaid coverage would also create tens of thousands of jobs in the state and be a huge boost for rural communities in the state, where hospitals are closing and health care is hard to come by. A 2018 study using nearly a decade’s worth of data found that hospitals in Medicaid expansion states were 84% less likely to close than facilities in non-expansion states.

In North Carolina, 11 rural hospitals have closed since 2006, with nine more at risk of closing in the coming years, and even more in the financial red.


Ultimately, Lambeth’s bill may or may not be the one that finally gets across the finish line. 

His proposal does not include certain measures that are critical to getting approval from Republicans in the state Senate, such as a provision that would allow some specialty nurses the freedom to practice without being supervised by a physician. 

“It’s not the bill that we need in North Carolina expanding Medicaid,” Sen. Majority Leader Phil Berger told reporters on Thursday.

The state House Health Committee has scheduled a hearing on Lambeth’s bill for Tuesday, with a second hearing anticipated in the House Finance Committee later in the day. The full House could vote on the bill as early as Tuesday afternoon or Wednesday morning.


  • Keya Vakil

    Keya Vakil is the deputy political editor at COURIER. He previously worked as a researcher in the film industry and dabbled in the political world.

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