North Carolina House leaders have called a Health Committee meeting for first thing Thursday morning, June 23, 2022, to vote on a bill that would direct the N.C. Department of Health and Human Services (DHHS) to develop a Medicaid Modernization Plan by December 15, 2022, complete with legislative recommendations.

The bill, “Rural Healthcare Access and Savings Plan,” would require that health officials make official recommendations on how to implement Medicaid expansion and legislative changes that would be needed to do so. The report is to be delivered to the General Assembly’s Joint Legislative Oversight Committee on Medicaid Rate Modernization and Saving. That committee would consist of six members appointed by Senate Leader Phil Berger and six members appointed by House Speaker Tim Moore. Moore and Berger would also each appoint a co-chair from among their appointees.

The hastily called committee meeting for Thursday morning sparked speculation across the legislative complex in Raleigh that the House is rejecting the Medicaid expansion plan passed 44-2 earlier this month by the Senate, HB 149, an effort led by Berger. 

“The move by legislative Republicans to entertain Medicaid expansion after 12 years is bizarre,” said Donald Bryson, president of the John Locke Foundation. “If anything, their fiscal faith in the federal government should have diminished over the last 18 months, which may lead to a nightmare for future state budgets.”

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.”

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,” and that it must include provisions to end expanded Medicaid coverage if the federal government fails to cover 90% of costs, as it has promised. NCDHHS 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. 

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

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 bill also says that “the General Assembly shall take action on or after December 16, 2022, to enact legislation to implement the Medicaid Modernization Plan, in whole or in part. No portion of the Medicaid Modernization Plan shall be implemented without legislative action taken on or after December 16, 2022, expressly authorizing implementation.”

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.