On Thursday, the North Carolina House gave final passage to H.B. 76, a bill to expand Medicaid, by a vote of 87-24. On Wednesday, the day prior, the vote was 95-21.

The bill now officially goes to Gov. Roy Cooper’s desk for his signature.

Donny Lambeth, R-Forsyth, spoke in support of H.B. 76 on the floor on Wednesday and urged his colleagues to vote in favor.

Cooper has been a longtime proponent of Medicaid expansion and issued a mostly supportive statement when legislative leaders announced the deal, although he said he wanted expansion implemented immediately.

At the time, Cooper said he looked “forward to reviewing the details of the bill.” Cooper can sign the bill, veto the bill, or not sign the bill, in which case it would automatically go into law after ten days.

The House took its final vote to approve Medicaid expansion on Thursday, with the outcome being 87-24 in favor of the bill.

Cooper is expected to sign the bill quickly. However, the component of H.B. 76 that expands Medicaid will not go into effect until lawmakers reach an agreement on the state budget for the 2023-24 fiscal year.

The following will go into effect as soon as Cooper signs the bill:

  • 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

These parts of the bill will go into effect once the budget is approved:

  • 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

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

“This is an historic step forward to increase access to healthcare for our rural communities,” said Speaker Tim Moore, R-Cleveland, who is a proponent of the bill. “Considering the HASP funds and the work provisions put in place in this bill along with other safeguards, our workforce will remain strong as we expand access to healthcare for those who need it in the most conservative and fiscally responsible way possible. I look forward to passing a strong conservative budget for North Carolina so that expansion can take effect.”

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

“This course reversal on Medicaid expansion is hugely disappointing,” said Donald Bryson, president of the John Locke Foundation. “[The legislature’s] failure to meaningfully address supply-side problems will only exacerbate the statewide healthcare shortage and drive up wait times and costs for the general public.”

House Bill 76 previously passed the Senate 44-2.

Senate Leader Phil Berger, R-Rockingham, wrote an op-ed in the Carolina Journal in support of this Medicaid expansion bill. Rep. Ben Moss, R-Richmond, wrote an op-ed in opposition to expansion.