The North Carolina House Health Committee discussed a bill Thursday that would direct the state health agency to come up with a Medicaid Modernization Plan, to expanding Medicaid with work requirements for the expansion enrollees. The bill would also require that the plan earmarks for behavioral health and substance abuse, and expansion of healthcare to rural areas.

“I think we are at a good point right now where we have something where we can address some real critical needs and we can do so in a way that is fiscally responsible to the taxpayers of this state,” said Speaker Tim Moore, R-Cleveland of the Rural Healthcare Access & Savings Plan Act.

Rep. Donny Lambeth, R-Forsyth, stressed that it isn’t a Medicaid expansion bill, but rather allows for discussion and planning. He said the bulk of the bill authorizes the Department of Health and Human Services (DHHS) Secretary Kody Kinsley to work with the federal Centers for Medicare and Medicaid Services (CMS) to come up with a plan specific to North Carolina.

“We don’t need a rubber stamp of a federal program that is overlaid in North Carolina, we need a North Carolina solution,” he said.

Moore called Kinsley “a great partner” in working out the negotiation of what the parameters of the plan might be. Moore emphasized fiscal responsibility and knowing what is in the plan before it is adopted.

“You can’t say Medicaid is going to be a panacea,” stressed Moore. “You can go to other states that have some of the most expansive things and they have worse problems.”

In other states that have expanded Medicaid under the Affordable Care Act, experts generally underestimated the size of Medicaid expansion enrollments, underestimated its cost, and overestimated its health benefits.

Moore said the plan directs Kinsley to move forward to apply for providing additional coverage to 600,000 people, 300,000 who are currently on Medicaid under COVID rules, all under the condition that the feds pay 90% of the cost and the state 10%. If the fed’s funding promise changes, Moore said, the bill ends the expansion program in North Carolina.

Inside the bill

The bill also lays out some requirements of NCDHHS’ proposed expansion plan including that, “Individuals who are not United States citizens shall not be covered except to the extent required by federal law.” 

DHHS is also required to establish a system of reporting back on enrollment numbers, whether enrollees are using the preventive care, and how it is impacting health outcomes. 

Part of the House’s bill also includes having a work requirement. Moore said he doesn’t want to see the General Assembly incentivize someone from getting a job and being self-sufficient. Bill writers put a work-type provision in the bill to recognize the working families who are playing by the rules doing all they can to get by but who struggle to access healthcare.

“I think one of the big things vexing our economy right now, and I would point to the feds mainly on this, is there are too many incentives for folks to stay home and not work as opposed to getting a job,” he said. “If you don’t believe me, try going to a Bojangles right now. It’s that way up and down the line anywhere you go in the state.”

Waivers to allow states to put work/volunteer requirements or a small co-pay into expansion plans were offered by Obama administration to encourage states to expand the program back when the Affordable Care Act passed. Under the Trump administration, states that expanded Medicaid had their work waivers approved, but the Biden administration has put a stop to them. Lambeth said if NC DHHS cannot get work requirement in the bill, they should look at adding a job training program.

The House bill also requires that $1 billion be spent on opioid, substance abuse, and mental health crisis in N.C. “using savings from the additional federal Medicaid match available under the American Rescue Plan Act (ARPA).” The ARPA is the $1.9 trillion plan passed by Congress in 2021 that economists are blaming for the nation’s historic inflation rate.  

Under the House legislation, a DHHS-created task force of leaders in the faith community, law enforcement professionals, mental health experts and addiction specialists would be required to guide the $1 billion in spending on drug and mental health issues.

The plan also has specific proposals to increase access to healthcare and preserve hospitals in rural areas of the state. Lambeth said North Carolina ranks 43 out of 50 states for access to healthcare and that 11 rural hospitals have closed since 2005, with 19 currently at risk of shutting down.

The directives for NCDHHS in the House bill do not include some of the industry reform measures that the Senate offered in its bill, including the SAVE Act, which would address needs in rural areas and giving nurses more independence, and partial repeal of some Certificate of Need Laws.

The next steps

Moore said if CMS approves of the plan, it will be voted on in December. The House’s bill, SB 408, states that “The Secretary of DHHS shall present this plan to the Committee at a Committee meeting to take place December 15, 2022. The Committee shall vote on its recommendation at that time.”

Moore said he wasn’t sure if the Senate will agree with the House’s plan but feels it is in the best interest of those in most need of assistance and of the taxpayer.

“I don’t know if the other chamber will agree with it or not,” he said. “If they don’t, so be it. This is a way to move forward with a plan that will actually help, at the end of the day, without causing the state any financial hit but help those that need help the most.”