Senate Passes Medicaid Expansion. Here’s What Happens Next

N.C. Senate floor. Source: Carolina Journal

By Alex Baltzegar
Carolina Journal

Last week, the Senate passed House Bill 76 (H.B. 76), legislation that will expand Medicaid by a vote of 43-2. The bill now heads to the state House for concurrence, and lawmakers there are expected to vote on it next week.

The two Senate ‘No’ votes were Sens. Norm Sanderson, R-Pamlico, and Eddie Settle, R-Wilkes. However, several Republican senators who had been opposed to Medicaid expansion in the last biennium were absent on Tuesday.

The House already passed H.B. 76, but modifications were made in the Senate after legislative leaders reached a deal to expand Medicaid, so the House will have a vote on the new version.

At least one House member changed his mind since the first vote, but the House is still expected to pass the bill.

Once the house approves, the bill will head to Gov. Roy Cooper’s desk, where he will have 10 days to sign it.

Cooper is expected to sign the bill quickly. However, the Medicaid expansion part of H.B. 76 will not go into effect until lawmakers reach an agreement on the state budget for the 2023-24 fiscal year.

The following will go into effect once the budget passes:

  • Medicaid coverage for adults aged 18-64 with incomes up to 133% of the federal poverty level, going into effect once the Centers for Medicare and Medicaid Services (CMS) approve the start date
  • Workforce development measures promoting employment among Medicaid enrollees

Here are the parts that will go into effect immediately:

  • Increased Medicaid reimbursements provided to hospitals through the Healthcare Access and Stabilization Program (HASP)
  • Increased hospital assessments to provide funding for the NC Health Works coverage and the HASP program at the start of the next fiscal quarter
  • Repeal Certificate of Need (CON) review for the following: psychiatric beds and facilities; chemical dependency treatment beds and facilities; replacement equipment up to $3 million, indexed to inflation; an aggregate total of $3 million diagnostic center equipment that individually exceeds $10,000; early and periodic screening, diagnosis, and treatment services to children under age 21 at home health agencies

Two years after the first HASP payment is made, ambulatory surgical centers will be removed from CON review if those centers meet the following requirements:

  • Licensed by DHHS
  • Located in a county with a population in excess of 125,000
  • Commit 4% of their total earned revenue to charity care

Three years after the first HASP payment is made, MRI machines in counties with a population in excess of 125,000 would be removed from CON review.

The SAVE Act, which would remove barriers for nurses to practice in North Carolina, is not included in the bill.

“We have a unique opportunity to expand coverage with federal funds already on the table,” said Speaker Tim Moore, R-Cleveland, a proponent of the bill. “The stakes are high, and the cost to the state is minimal.”

Opponents of the bill argue that this bill doesn’t go far enough to address supply-side problems.

“This course reversal on Medicaid expansion is hugely disappointing,” said Donald Bryson, president of the John Locke Foundation. “[The legislature’s] failure to meaningfully address supply-side problems will only exacerbate the statewide healthcare shortage and drive up wait times and costs for the general public.”


  1. So CON review for large counties but the small counties still get to deal with ridiculous CON oversight, not good since the smaller counties are the ones that need access to services more. Another win for the big hospitals and a loss for the small ones.

  2. I appreciate the loosening of CON. Tough deal to make, but I would have made it until we can get actual costs down. Now the work of breaking the public/private provider oligarchy can really start.

  3. “We have a unique opportunity to expand coverage with federal funds already on the table,” said Speaker Tim Moore, R-Cleveland, a proponent of the bill. “The stakes are high, and the cost to the state is minimal.” He will regret saying this……

  4. Thank you to the real conservative GOP reps who hold the line against expanded government and increased spending!!! Oh wait……. #hypocrites #RINOs #VoteOutIncumbents

  5. Every single time the government gets involved in something the costs go exponentially higher. They never come down. That’s the lie politicians always use to sell something. Student loans and healthcare are just a few examples. The working class will continue to have to pay more for our insurance and doctor’s visits and shoulder the burden for those who pay nothing and in most instances don’t work. And save it, those of you who want to say something ridiculous about kids, extremely poor, and disabled people. Everybody agrees they need coverage and nobody is opposed to helping them. It’s the dead beat able bodied people who can but choose not to work that are leaching off our system that need to be cut off.

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