Is Medicaid expansion still possible in North Carolina? What we know

North Carolina lawmakers have spent years at loggerheads over Medicaid expansion. While Democratic lawmakers defended the Obama-era provision, Republicans rejected it.

That changed during this year’s legislative session. For the first time in nearly 10 years, Republicans and Democrats have agreed to continue expanding Medicaid.

But in the end, they couldn’t come to an agreement.

In the Republican-drafted state budget, which Democratic Gov. Roy Cooper signed into law on Monday, Medicaid expansion is conspicuously absent. Why didn’t lawmakers expand Medicaid if there was bipartisan support? Is further discussion irrelevant? And what would expanding Medicaid mean for North Carolina residents?

The News & Observer has answers for you here.

Governor Roy Cooper signed into law the Republican-written state budget on Monday. The bill does not include the expansion of Medicaid. Angelina Katsanis [email protected]

What is Medicaid? And what would its expansion mean?

Medicaid is a health insurance program for low-income families. It is run at the state level, but partly funded by federal dollars.

Medicaid should not be confused with Medicare, a federally run system reserved primarily for older Americans.

The Affordable Care Act of 2010 authorized state governments to increase Medicaid eligibility with federal funding. Prior to the ACA option for Medicaid expansion, most eligible applicants had either a disability or minor children. In states where Medicaid has been expanded, almost all adults whose incomes are up to 138% of the federal poverty level can benefit from public insurance arrangement.

So far, 38 states and Washington, DC, have adopted Medicaid expansion programs.

If North Carolina expanded its access to Medicaid, about half a million uninsured residents would be eligible for coverage.

Is it still possible for NC to expand Medicaid?


Legislative leaders pledged to continue discussions on expanding Medicaid.

Phil Berger, leader of the Republican Senate BRYAN ANDERSONAP

“The General Assembly passed the 2022 budget with strong bipartisan support, and we are thrilled that Governor Cooper has signed this responsible spending plan,” Senate Leader Phil Berger and House Speaker Tim Moore said Monday. , both Republicans.

“Going forward, we are committed to working together to improve access to health care and expand Medicaid, while providing the safeguards needed to preserve fiscal strength for the state. Active negotiations are now taking place to that end.

But the General Assembly must act quickly or it risks losing some additional federal contributions. If the state doesn’t expand Medicaid before the end of the year, it leaves a $1.5 billion bonus on the table.

The federal government will still pay 90% of the costs, even without this premium.

At the end of this year’s session, Moore suggested that a Medicaid expansion plan could be in place by December. Berger has not indicated when he hopes to complete an expansion proposal.

Speaker of the House Tim Moore File photo News & Observer

For Democrats, Republicans’ widespread interest in expanding Medicaid is a turning point.

“I’m glad the House is actually considering doing something with Medicaid,” Rep. Robert Reives, the House Democratic leader, told the N&O. “And I think the important part is that whatever happens with this bill, it means we now have a full conversation going on, and that’s extremely important.”

So why was it not part of this year’s budget?

Lawmakers agree they want to expand Medicaid. They disagree on how.

For example, a Senate bill this session called for the immediate expansion of Medicaid. A proposal from the House suggested first a more in-depth study.

While the Senate bill would have made massive changes to the state’s health care industry, the House opposed such a sweeping reorganization.

Neither house could agree to a compromise in time for the legislation to pass independently or as part of the larger state budget.

Journalists Dawn Baumgartner Vaughan and Will Doran contributed to this story.

This story was originally published July 11, 2022 6:46 p.m.

Raleigh News & Observer related stories

Lars Dolder is editor of The News & Observer’s Insider, a state government news service. He oversees exclusive product content and works with The N&O Policy Office on investigative projects. He previously worked in The N&O’s business office covering retail, technology and innovation.

Julio V. Miller