On Tuesday evening, the House voted 111-0 in favor of passing a House committee substitute bill to SB 403, “Additional Medicaid Funds and Requirements,” that fully funds the Medicaid rebase, but it may not matter as the Senate most likely won’t take up the measure before an Oct. 1 deadline.
The Senate passed its version of the bill on Monday evening after it was discussed in the Senate’s Appropriations/Base Budget Committee.
Unless the Medicaid program gets extra funding by that date, there will be cuts to Medicaid reimbursement rates.
“This is a crisis that we are facing in just a few days,” said Rep. Grant Campbell, R-Cabarrus, who is also a physician. He told the House Rules Committee earlier in the day that the Medicaid rebase has been increasing at a fiscally unsustainable rate for several years, with double-digit percentage growth becoming a regular occurrence.
WHAT THE BILL INCLUDES:
SB 403 adds $192 million in funding, on top of the $600 million previously approved, bringing this year’s total Medicaid rebase and administration investment to $792 million.
The bill relies on strategic savings and reallocations, including:
- Eliminating vacant positions at NCDHHS.
- A 5% flexible vacant position cut across other gubernatorial state agencies.
- Ending Medicaid coverage of GLP-1 drugs for weight-loss only, while continuing coverage for federally required medical diagnoses.
It also tightens oversight and accountability by:
- Directing the state auditor to review SNAP and Medicaid redetermination processes at the state and county levels to clear backlogs.
- Requiring NCDHHS to work with the auditor’s office to set standards for timeliness and accuracy in Medicaid redeterminations, with enforcement tools to ensure county compliance.
- Expanding Rylan’s Law to include Medicaid redeterminations, ensuring greater consistency and accountability statewide.
Campbell said the bill is a “clean bill” with no preconditions or games and nothing else added.
He added that those who care about it being a “clean bill” include hospitals, doctors, nurses, dentists, psychologists, and others in the medical field, but most importantly, those who are sick and their families.
“The proposed cuts are severe, and they are scheduled to begin next week, anywhere from 3 to 10% for things like hospital stays, primary care, dental care, behavioral health. And I could go on and on,” Campbell said. “There are health care providers all over the state that are already planning layoffs, and some are trying to decide whether to even continue seeing Medicaid patients at all. These cuts are not, I repeat, not necessary next week.”
He added that NCDHHS would not run out of funding before the short session next year, as they were already provided with $600 million in extra funding, more than enough to get to the mark where they could adjust the rebase as needed.
Campbell was also critical of the actions of Democratic Gov. Josh Stein and the Senate.
“There’s time to do this right, but the governor has decided, with very little notice, to threaten not us, but the North Carolina residents needing health care, with massive cuts that will begin months before they have to,” Campbell said.
Legislators, such as Reps. Donny Lambeth, R-Forsyth, and Maria Cervania, D-Wake, stated they weren’t comfortable with the Senate version and all of the things added to the bill.
She also said that despite her disagreement with the bill’s provisions, including the elimination of $20 million in vacant positions across state agencies and the suspension of coverage for weight loss drugs, she would vote for it.
“Medicaid is the backbone of health care for more than 2.8 million of our North Carolinians,” Cervania said, “We must keep negotiations going and ensure the rebase funding stays on track.”
Rep. Zach Hawkins, D-Durham, told legislators that it will be devastating as to what will happen with these cuts as of Oct. 1.
“These reductions, ranging from 3 to 10% strike across every corner of the care system, group homes — ICS, autism, therapy, personal care, assistance supported employment programs, and even the primary and specialty positions who keep those folks healthy,” Hawkins said. “For the individuals that are served, these are not just isolated services that can be trimmed without consequence. They are interdependent lifelines.”
Hawkins said he implored those in the Senate to send a bill that everyone can vote on.
“This isn’t about leverage; this is about doing what’s right for the people of North Carolina because Oct. 1 will be exponential for them,” he said.
Rep. Sarah Crawford, D-Wake, said that as a CEO of a Medicaid provider agency, she sees firsthand how Medicaid is a lifeline not only for families but also for providers and the workforce that shows up to provide those services.
The Senate’s original version of SB 403 also included work requirements for Medicaid that were dropped in the House version and were not included in the Senate bill passed on Monday.