After years of waiting, expansion of Medicaid to roughly 600,000 North Carolinians is now state law but has a caveat before it goes into full effect.
“First of all, unquestionably great news. We have been hoping for this or a long time and we’re really grateful for the legislature for getting this past the finish line,” said Dr. William Hathaway, CEO of the Asheville-based Mountain Area Health Education Center, which covers the 16 counties of Western North Carolina, including Macon County.
“This expansion will bring stability and greater access to care for roughly 600,000 hard-working individuals and families across our state,” said Nancy Lindell, spokesperson for Mission Health, in a March 23 statement. “We appreciate the support of Sen. [Kevin] Corbin and Rep. [Karl] Gillespie, who represent our district, and we are excited about the passage of this historic legislation that will help so many.”
Gillespie said there’s “no doubt that the bill will help a lot of constituents.”
The act, House Bill 76, originally passed the N.C. House on Feb. 16 by a 92-22 margin. Then after a compromise on certain aspects of the bill was reached with the N.C. Senate, it passed the Senate on March 15 by a 44-2 margin. The compromise bill passed concurrence back in the N.C. House 87-24 last Thursday, March 23.
Gov. Roy Cooper, a longtime proponent of Medicaid expansion, signed HB76 into law on Monday, March 27, making North Carolina the 40th state to sign on.
“Medicaid expansion is a once-in-a-generation investment that will strengthen our mental health system, boost our rural hospitals, support working families and so much more,” said Cooper. “This is a historic step toward a healthier North Carolina that will bring people the opportunity of better health and a better life.”
Hathaway said this legislation will impact thousands in WNC. “We could see between 50,000 and 60,000 people get access to primary care and services [in WNC],” he said. “We know people who have a primary care home have better outcomes.”
Proponents of Medicaid expansion have long said that this would allow low-income populations, which are typically more at risk of chronic illness, to get more preventative services and thus create a more healthy workforce.
“Even in schools, imagine kids who get access to healthcare, they miss less school, succeed more, their parents have access, and have less time missing work,” Hathaway said. “Healthy communities are vibrant communities, which are the foundations to so many communities, including economic development.”
The ripple effects of more people getting preventative care will manifest themselves more over the course of several years, Hathaway said.
Medicaid expansion is likely to help federally qualified health centers, who service a lot of low-income patients that use sliding scale or free healthcare options.
Hathaway anticipates Medicaid expansion, after it gets final approval from the national CMS, to go into effect by the start of 2024.
The caveat
According to the bill, the actual Medicaid expansion will provide coverage to adults aged 18-64 with incomes up to 133% of the federal poverty level. The fiscal impact summary of HB76 states that 133% of the federal poverty level is an annual salary of $19,391 for an individual or $33,064 for a family of three.
However, Medicaid expansion won’t go into effect until the 2023-24 biennium budget is passed, according to the text of the bill.
While HB76 had bipartisan support, state biennium budgets, which come up in odd-numbered years, aren’t as much of a slam dunk. Cooper, a Democrat, and the Republican-led NCGA have clashed over the budget during Cooper’s time as governor.
Gillespie said one thing he would have liked to see in HB76 is a funding mandate for the counties.
“Hopefully as we go through our budget process that’ll happen,” Gillespie said.
However, Hathaway is hopeful this year’s proposed state budget by the NCGA won’t have any deal-breaking caveats.
“That’s the big kicker,” Hathaway said of the budget provision. “It would create a lot of ripples to prevent this from happening.”
HB76 didn’t include just Medicaid expansion, as it has a workforce development program included. That program would encourage and provide job resources to Medicaid enrollees. Previously, states that have tried to mandate work requirements in their Medicaid expansion have had those mandates defeated in court, but encouragement programs are still legal. Gillespie said even though it’s been ruled unconstitutional, he said he would like to have had “some guardrails” to make sure those Medicaid expansion recipients are able to work and find a job. Gillespie said having a work mandate would “protect the citizens of North Carolina.”
Certain parts of the bill go into immediate effect. One of those regards the increased federal Medicaid reimbursements provided to hospitals through the Healthcare Access and Stabilization Program [HASP]. The federal government covers 90% of Medicaid expansion costs, with the other 10% coming from the hospitals that will benefit from the reimbursements.
Cooper said Monday that North Carolina will receive $521 million a month from the federal government for the Medicaid expansion.
Another part that goes into immediate effect is the peeling back of Certificate of Need requirements. According to the NCDHHS, the Certificate of Need law “prohibits health care providers from acquiring, replacing, or adding to their facilities and equipment, except in specified circumstances, without the prior approval of the Department of Health and Human Services.”
The Certificate of Need rollbacks included in HB76 deal with certain medical equipment, such as psychiatric beds, chemical dependency treatment facilities, treatment services to persons under the age of 21 at home health agencies.