Senate Passes Medicaid Expansion. Here’s What Happens Next

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.”