In a press conference Thursday, Senate Leader Phil Berger and House Speaker Tim Moore announced that an agreement has been reached between the chambers to expand the federal Medicaid entitlement program in North Carolina.

The state is one of eleven to have not done so yet as part of the Affordable Care Act. Under the ACA, North Carolina would be responsible for 10% of Medicaid expansion moving forward. The federal government has promised to pay 90%. An estimated 600,000 able-bodied working-age adults would likely be added to the Medicaid program.

North Carolina will receive an initial $1.5 billion bonus, of sorts, in federal dollars for expanding Medicaid, as well as $800 million in annual recurring revenue from the federal government, according to Moore and Berger.

The initial $1.5 billion and $800 million recurring federal dollars coming into the state “is not tied to any particular part of the state budget, so that’s just additional dollars,” Berger said.

Of note, the SAVE Act, which would remove barriers for nurses to practice in North Carolina, was not included in the initial House and Senate agreement. Some “Certificate of Need” reform was included in the agreement, including the following:

  • Eliminating Certificate of Need for behavioral health beds.
  • Eliminating Certificate of Need for chemical dependency beds.
  • Raising the replacement equipment threshold to $3 million and indexing annually to inflation.
  • Increasing the threshold for diagnostic centers to $3 million and indexing annually to inflation.
  • Eliminating Certificate of Need for MRIs in counties with populations above 125,000, effective three years from the first H.A.S.P. payment.
  • Eliminating Certificate of Need for ambulatory surgical centers in counties with populations above 125,000, effective two years from the first H.A.S.P. payment.
  • Surgical centers that are exempt from Certificate of Need will be required to have a 4% charity care requirement for those centers in counties with populations above 125,000.

Lawmakers say that Gov. Roy Cooper, a proponent of Medicaid expansion since taking office in 2016, was not involved in the negotiations; only House and Senate members were. Lawmakers will present him with the agreement later today.

“Medicaid expansion would be effective only upon passage of the 2023 budget,” Berger said. Berger also said Governor Cooper would disagree with this timing and argue it should be effective immediately.

Cooper released the following statement after the press conference concluded:

Donald Bryson, president of the John Locke Foundation, released a statement following the announcement:

The CEO of the N.C. Medical Society, Chip Baggett, said the proposal “represents a true commitment to the people of North Carolina and their health.  It is legislation the NCMS has long considered of utmost importance and we thank everyone who has helped move it forward.”

Another thing noteworthy from the press conference—Moore said the budget process would be complete by June 30th.

“June 30th is the magical date for all of this,” Moore said. “I see no reason that we don’t get there. Things are moving well. If you look at the cooperation between the House and the Senate, it’s probably the best this year it’s been in a long time.”

Berger indicated that there has not yet been an agreement between the chambers on how much the state will spend in the upcoming budget.

This is a developing story. Follow @carolinajournal and Carolina Journal political reporter @alexbaltzegar on Twitter for more updates.