Budget Stalemate Could Delay Medicaid Expansion Into November

North Carolina Democratic Gov. Roy Cooper signs a Medicaid expansion law at the Executive Mansion on Monday, March 27, 2023, in Raleigh, N.C. (AP Photo/Hannah Schoenbaum)

By Michael McElroy

September 5, 2023

State health officials need at least 30 days to implement Medicaid expansion to cover an additional 600,000 North Carolinians. But first they need lawmakers to pass a budget.

North Carolina lawmakers voted to expand Medicaid in March, but the Republican-led legislature said it couldn’t go into effect until there is a state budget, even though the federal government will pay for more than 90% of the costs of the expansion.

Nearly six months later, Republicans have still not passed a budget.

This means that those 600,000 are still unable to go to the doctor, afford life-saving medication, or address the health problems they’ve been unable to treat because they lack insurance.

Even when there’s a budget, however, state health officials will still need another 30 days or so to push all the buttons and pull all the levers that make Medicaid expansion work. Their fingers have been poised over the buttons for months.

The General Assembly says they’ll probably vote on a budget sometime this month.

If the budget had passed by Sept. 1, Kody Kinsley, NC Health and Human Services Secretary, said last month, officials would have been able to have things up and running by Oct. 1. Now, that’s not going to happen. Instead, it may take closer to Thanksgiving for Medicaid expansion to go into effect.

“It’s become clear to us that we will not be able to have a budget passed in time and enacted, nor will we have separate authority to move forward,” Kinsley told the Associated Press last week.

‘Life and Death’

Republican leaders have ignored repeated calls from Democrats to separate expansion from the budget negotiations.

“This General Assembly’s failure to enact a budget, and therefore expand Medicaid, is having a severe impact on people who rely on that care or who will benefit when it is expanded,” Senate Democratic Leader Dan Blue and House Democratic Leader Robert Reives said in an emailed statement last month.

“For many people, this is genuinely a matter of life and death. It is long past time for Republican leaders to come back from vacation and get to work.”

Republicans have a supermajority in the both chambers of the legislature. They’ve been unable to come to an agreement amongst themselves and spent most of August on summer vacation.

Senate leader Phil Berger and House Majority leader Tim Moore, both Republicans, said they had every intention of expanding Medicaid, but that some of the disagreements in the budget centered on how to spend the federal money that comes with expansion.

Once there’s a budget agreement and legislators vote to pass it, health officials can start the 30-day countdown.

“Our team will continue to work hard to have all of the tools ready and necessary to move forward on expansion, just as soon as we have clarity from the General Assembly about our ability to do so,” Kinsley said.


  • Michael McElroy

    Michael McElroy is Cardinal & Pine's political correspondent. He is an adjunct instructor at UNC-Chapel Hill's Hussman School of Journalism and Media, and a former editor at The New York Times.

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