Gov Roy Cooper and NCDHHS Secretary Kody Kinsley announced Monday that Medicaid expansion will begin on Dec. 1.

“This will be a new day for healthcare in North Carolina,” Cooper, a Democrat, said in a press conference. “To all of the longtime supporters and to those who are just now seeing the light, I say thank you.”

This will add hundreds of thousands of working-age, able-bodied adults to the state’s Medicaid program, making it the largest single expansion of an entitlement program in state history.

“Medicaid expansion is a game changer for 600,000 North Carolinians that it will directly benefit,” said North Carolina Department of Health and Human Services Secretary Kody Kinsley, who said he grew up in North Carolina without health insurance and knows first-hand the struggle that families face.

“It’s a game changer for healthcare providers and for hospitals, especially in rural North Carolina, who now, with incoming payments of federal dollars through Medicaid, will be able to sustain their operations and keep their doors open,” he said. “It’s a game changer for North Carolina’s economy which will have the benefit of billions of dollars flowing into North Carolina, dollars that we had left behind for too long.”

Kinsley said that of the 600,000 people who are eligible for coverage through the expansion, about 300,000 will be moved into full coverage on Dec.1. The remainder will be enrolled as they come forward to the state’s county partners.

Medicaid expansion became possible with the passage of H.B. 259, the state budget, on Friday. 

Shortly after the Senate passed the budget Friday, Cooper said he would let the bill become law without his signature, citing the importance of Medicaid expansion.

He continued on the same track on Monday. 

“I know there’s a lot of bad in the budget that they’ve passed and I expect lawsuits to challenge the constitutionality of a number of parts and I cannot in good conscience sign my name to it, and even though a veto of this budget would have been well deserved, that would take this bill out of my hands and send it back to this legislature where even more mischief could have put Medicaid expansion at risk in this legislative circus,” Cooper stated.

The Republican-controlled legislature originally agreed to the measure being carried out, but only if it were tied to the passage of the budget. Although unhappy with the contingency, Cooper signed Medicaid expansion into law on March 27

There was some concern last week when a proposal was floated to members that would pull Medicaid expansion from the budget and combine it with the legalization of casinos in another bill. That move proved to be unpopular, and Medicaid expansion was put back into the budget, with the casino measure on hold for the foreseeable future. 

Kinsley said the passage of Medicaid expansion unlocked a $1.6 billion in federal taxpayer-paid funds to come into North Carolina to make key investments in healthcare.

“I’m proud to report that the legislature did invest about $700 million of the governor’s billion-dollar investment plan in behavioral health,” he said. “Several hundred million of those $700 million are recurring that will come every year to make key investments in behavioral health rates a key priority for the department. Policy investments that will allow us to better serve people with serious behavioral health and intellectual and developmental disabilities.”

He also said the expansion will allow for investments in emergency departments and Division of Social Services (DSS) offices across the state. There will also be $200 million to support the state’s child and family well-being work, allowing them to better serve children and people in hospitals.

Opponents of Medicaid expansion were not happy with the outcome when the original bill was passed in the spring, saying that the bill didn’t go far enough to address supply-side problems.

Of the state’s 27 Certificate of Need laws, the expansion bill repeals only 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.

“Gov. Cooper tried to expand Medicaid by Executive Order, and it has been his top priority during his tenure,” John Locke Foundation Chief Executive Officer Donald Bryson said in March. “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.”