Cooper signs NC’s Medicaid expansion into law

Gov. Roy Cooper signing Medicaid Expansion into law, March 27, 2023., Livestream.

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  • "Today is a loss for conservatism," said Donald Bryson, president of the John Locke Foundation.

Democrat Gov. Roy Cooper signed the Medicaid expansion bill Monday afternoon outside the Governor’s Mansion.

“This law, once implemented, will be the working families bill of the decade,” Cooper remarked. “The strength of our communities depends on the health of our people. Today is a historic step toward a healthier North Carolina.” 

It’s projected that over 600,000 North Carolinians will be eligible for Medicaid once the bill becomes law. Elements of the bill were written to be contingent on the governor signing the legislature’s state budget, but parts go into effect immediately.

Cooper said with the signing of the bill, those who are uninsured will avoid financial ruin from unpaid medical bills, more rural hospitals will be able to stay open, and people will have access to more doctors, nurses, and mental health professionals because there will be more people who can pay them.

He thanked both Democrats and Republicans of the General Assembly who voted in favor of H.B. 76, singling out Republicans who changed their minds on the issue, saying they did the right thing and that historic gains were made for healthcare competition in the state.   

As he did in the past, Senate Leader Phil Berger, R- Rockingham said North Carolina had a broken Medicaid system, and there was no way it could have handled an influx of hundreds of thousands of new enrollees. He said transforming the program from a fee-for-service model to a managed care model provided better budget predictability and put more focus on the quality of care. But before they could give out more insurance cards, he said it was necessary to address the cost and availability of healthcare with Certificate of Need (CON) reforms.

Of the state’s 27 Certificate of Need laws, the expansion bill repeals two on addiction and mental health beds, and replacement equipment up to $3 million, and repeals two CON laws for only the 23 largest counties, two to three years after federal HASP payments to the hospitals begin. N.C. remains the fourth most CON regulated state in the nation.

“(The reforms) takes direct aim at regulations that are the biggest impediments to the availability of health care and the regulations that increase cost,” Berger said. “These changes will make North Carolina more attractive for providers, healthcare facilities, and hospitals willing to do business and to compete here in North Carolina. So, while this is a momentous occasion, our work is not done.”

Berger said Medicaid expansion won’t solve all of the problems citizens encounter as there is still a provider shortage in the state, and they need to continue with additional supply-side reforms, to chip away at rules that prevent citizens from accessing healthcare.

House Speaker Tim Moore, R- Cleveland, said there is a significant shortage when it comes to behavioral health and that great strides will be made in that direction with the passage of the bill. He also said it would have a tremendous effect on rural healthcare. 

“The amount of money that’s going to come in through the hospitals through HASP to put more money into direct care to provide services to rural areas is something that will be of a generational impact as we work through this process,” he said. 

The House voted 87-24 on March 23, giving the bill final passage.

While Cooper may have been jubilant at today’s signing, not all of H.B. 76 will go into effect immediately.

The bill is broken down into two different components. 

The following 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 certain requirements.

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 second component, which expands Medicaid, will not go into effect until the budget is approved. It includes the following;

  • 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

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

Cooper didn’t seem too concerned about having the second component tied in with the budget at the signing ceremony. He told reporters that he feels confident.

“I think what’s important about this is that we have agreed on how to expand Medicaid, and it’s only a question of when and not if, and I think that’s where we are right now,” he said. “We know that this is going to happen, it’s just a question of when and the House and the Senate seemed to be excited about going ahead and doing a budget early, so that’s good to hear.”

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

“Nearly 2,300 days ago, Gov. Cooper tried to expand Medicaid by Executive Order, and it has been his top priority during his tenure,” said John Locke Foundation president Donald Bryson. “Now Republican legislative leaders have given Cooper his biggest victory, given a seal of approval to Obamacare, and sent the state budget into uncharted waters. Today is a loss for conservatism.”