Senate Republicans propose Medicaid expansion bill

FILE - Republican Senate leader Phil Berger speaks Aug. 24, 2021, in Raleigh, N.C. North Carolina Senate Republicans are strongly considering legislation Monday, May 23, 2022, that would expand Medicaid coverage to hundreds of thousands of additional low-income adults. (AP Photo/Bryan Anderson, file)

RALEIGH — After a decade of concerns over cost, N.C. Senate Republicans have embraced Medicaid expansion. A bill introduced Wednesday which is moving its way through the legislature would accept federal funds to expand the program by hundreds of thousands of enrollees to the entitlement.

North Carolina is one of a dozen states that have not expanded Medicaid as of this year.

At a press conference led by Senate Leader Phil Berger (R-Eden) and state Sen. Joyce Krawiec (R-Forsyth), lawmakers laid out the case for accepting the expansion in exchange for supply-side reforms in the state’s healthcare system.

“If there is a person who has spoken out against Medicaid expansion more than I have, I would like to talk to that person about why my view has changed,” said Berger. “We need coverage in North Carolina for the working poor.”

Berger said there was “no fiscal risk” to the state budget and that the state’s Medicaid program has been reformed and transformed in the past several years.

In an Associated Press report last week, Berger confirmed he was open to expansion in state budget negotiations. He said he was now convinced the federal government’s 90% share of expenses for expansion enrollees would not soon be eliminated.

Some Republicans in the legislature are also intrigued because the 2021 federal COVID-19 relief law would give North Carolina $1.5 billion over two years to treat traditional Medicaid patients if it accepts expansion.

An early bill summary says the expansion proposal would cover adults making up to 38% above federal poverty guidelines, likely covering at least 600,000 people. Currently, about 2.7 million North Carolina residents are enrolled in Medicaid. 

The bill that is making its way through the committee includes what the senators described as a “significant” certificate of need (CON) reforms. CON laws require state health regulators to sign off on any expansion plans by hospitals and other medical providers. The issue of CON reform has been a longtime fixture for conservative legislators and nonprofits.

In addition, work requirements are included in the bill. That would prove ripe for a legal challenge, however, as has happened in many other states implementing Medicaid expansion. Federal approval of work requirement waivers are still pending in nine states.

The bill says the state’s 10% share of expansion expenses would be paid through a new assessment on hospitals. Expansion would end if Congress increased the state’s share. The program also would include a work requirement for expansion recipients — a mandate that in other states has been struck down by federal courts and blocked elsewhere by President Joe Biden’s administration.

The measure also would permit nurse practitioners, certified nurse-midwives, and nurses with other advanced specialties to practice without a physician’s formal supervision. The legislation also would require health insurers in the state to cover telehealth services, and in-network health facilities would have to alert consumers when out-of-network providers are scheduled to provide care.

If the bill passes the Senate, its fate in the N.C. House of Representatives is presently unknown. House Speaker Tim Moore (R-Kings Mountain) said he did not see support last year within the House Republican Caucus for expansion, although a bill was introduced in the chamber three years ago.

Talking to reporters last week, Moore said he “would be surprised” if a Medicaid expansion agreement could be reached with the Senate before the work session ended, the AP said.

Gov. Roy Cooper, a vocal supporter of Medicaid expansion, has not commented as of Wednesday morning on the Senate bill.

This is a developing story and will be updated.