NC Lawmakers Reach Deal to Expand Medicaid Health Insurance to Cover 600,000 More Residents

Medicaid expansion has been shown to save lives, improve postpartum maternal health outcomes, expand access to mental healthcare and substance use, and prevent rural hospitals from closing. 

After a decade of delays, Republican leaders in the North Carolina General Assembly on Thursday announced they’ve reached an agreement to expand Medicaid health insurance coverage to 600,000 more North Carolina residents. 

In a press conference, House Speaker Tim Moore and Senate leader Phil Berger announced the deal between the two Republican-majority chambers. The House passed a Medicaid expansion bill last month, and Berger announced Thursday that the Senate would modify the House-approved bill. 

The deal, which likely won’t be voted on until later this month, represents a significant reversal from Republicans. Democrats, including Gov. Roy Cooper, have supported expanding Medicaid for years, but were met with resistance from Berger, Moore, and other members of their party.

Berger and Moore said they have not yet talked to Cooper about their agreement, which would allow new beneficiaries to enroll in January.

In a tweet posted after the news conference, Cooper called the agreement “a monumental step that will save lives,” but said he wants it to take effect immediately “to make sure we leverage the money that will save our rural hospitals and invest in mental health.”

As many as 600,000 low-income North Carolinians—including 100,000 with children at home—could benefit from expansion, which is made possible by the Affordable Care Act (ACA). These individuals make too much to qualify for conventional Medicaid, but not enough to receive subsidies under the ACA.

Thirty-nine states have adopted the ACA’s Medicaid expansion, an opt-in program that allowed states to expand Medicaid health insurance 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 100% of the cost for the first several years, and 90% of costs as of 2020. 

Under the House-passed bill from Republican Rep. Donny Lambeth, hospitals would pay for the remaining 10%, and they would in turn benefit from being reimbursed as they cover patients with Medicaid.

Thanks to President Biden’s 2021 American Rescue Plan, North Carolina would also receive a $1.5 billion payment from the federal government to treat traditional Medicaid patients if the legislature agrees to expand Medicaid. Berger also said the package will include measures that would result in higher reimbursements—possibly up to $3 billion annually—for hospital systems when they treat Medicaid patients.

Medicaid expansion has been shown to save lives and improve postpartum maternal health outcomes. It would also expand access to mental healthcare and substance use treatment amid the state’s growing mental health and addiction crises.

“If we can get more people on Medicaid, they would have 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. 

Expanding Medicaid coverage would also create tens of thousands of jobs in the state and be a huge boost for North Carolina’s rural communities, which have seen 11 hospitals close since 2006. 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.

Dana Bango, a cancer survivor and rural North Carolina resident, is one of the 600,000 individuals who would benefit from Medicaid expansion. In a recent interview, she told Cardinal & Pine what it would mean to her.

“The thing that hangs over my head is what if something else happens? What if [my cancer] recurs? What if I have an accident? I’m already 30 grand in debt [from my treatment] and something else can happen again,” Bango said. 

Medicaid expansion would relieve that chronic stress and reduce her financial insecurity, Bango said. Most importantly, health insurance would improve Bango’s odds of staying healthier longer and seeing her 17-year-old daughter grow up. 

“My daughter’s getting ready to graduate high school. I want to see her live a little bit. I don’t think it’s time for me to go yet,” Bango said. “I want to see her grow up. I want to be part of her life as much as possible…The main thing that I want now is to be here for her and to be here for her, I have to be healthy and I have to be alive.”

Under the deal reached by Berger and Moore, the Senate will update the bill to loosen “certificate of need” laws that require health regulators to approve medical providers’ expansion plans.

Moore and Berger said their agreement would only go into effect after a state budget is enacted, most likely in the early summer.

The Associated Press contributed to this report.