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House, Senate leaders reach deal on Medicaid expansion for North Carolina

North Carolina House Speaker Tim Moore, center, speaks at a news conference about a Medicaid expansion agreement, Thursday, March 2, 2023, at the Legislative Building in Raleigh, N.C.
Hannah Schoenbaum
North Carolina House Speaker Tim Moore, center, speaks at a news conference about a Medicaid expansion agreement, Thursday, March 2, 2023, at the Legislative Building in Raleigh, N.C.

Updated at 2:15 p.m.

After months of failed negotiations, North Carolina House and Senate leaders announced an agreement to expand Medicaid on Thursday.

The proposal would expand the government-funded health care program to an estimated 600,000 people. North Carolina has been one of a handful of states that haven’t expanded Medicaid under the Affordable Care Act.

The federal government pays the majority of the cost of expansion. Until last year, Republicans in the state legislature had opposed the idea. They changed their minds, but couldn’t agree on whether to include other new health care regulations. The Senate had sought to reduce health care facility regulations known as Certificate of Need, but the state’s hospitals — and the House — initially said no.

The compromise now calls for a less dramatic reduction in those regulations. Senate Leader Phil Berger said his chamber will modify a Medicaid expansion bill that passed the House last month and pass it in the coming weeks.

“We will move with all deliberate speed to move this forward,” Berger said.

Expansion wouldn’t take effect until this year’s budget is approved, likely this summer.

“Expanding Medicaid is a big deal for North Carolina and the more than half a million people it would help,” House Democratic Leader Robert Reives said in a statement. “It would increase access to care and help rural hospitals stay open. This is long overdue, but we still have work to do so that ensure this deal allows us to fully access federal funds.”

The bill would also add North Carolina to another federal health care funding program known as HASP.

Between HASP, which sends funding directly to health care providers, and a federal “signing bonus” for new Medicaid expansion states, the N.C. Department of Health and Human Services says the state will get $8 billion annually "with no additional cost to the state, along with $1.8 billion which can support behavioral health, public safety support, rural health care, and other needs.”

For comparison, the state government’s total budget this year is about $28 billion. Berger said the urgency to approve HASP was a major factor in getting various health care industry groups to reach an agreement. The deal came together Wednesday night.

Several health care proposals that the Senate included with its Medicaid expansion bill last year didn’t make the final cut.

One of them is the “SAVE Act,” legislation that would expand the role of advanced nurses and allow them more freedom to practice without a doctor’s supervision. Some House leaders oppose that change, thanks in part to strong opposition from groups representing doctors and anesthesiologists.

The reduction in Certificate of Need regulations reflects a compromise with the state’s hospitals. Under the plan announced Thursday, health care providers would no longer need to compete for regulatory approval to build new behavioral health and addiction treatment facilities, as well as new surgical centers in urban counties.

“I believe that this agreement represents the most significant modification of CON law in North Carolina since we began having a Certificate of Need requirement,” Berger said.

The N.C. Healthcare Association, which represents hospitals, said in an email that the CON compromise will “continue to protect access to care for all, especially in rural communities.”

A handful of Republicans still oppose Medicaid expansion. When the bill passed the House last month, 22 GOP lawmakers voted no.

Donald Bryson, president of the conservative John Locke Foundation and Civitas Action, reacted to a Tweet regarding the source of the funding.

"Let's not act like this is a fiscally conservative stance," he said highlighting that it is "taxpayer money" from the federal level.

WUNC's Jason de Bruyn contributed to this report.

Colin Campbell covers politics for WUNC as the station's capitol bureau chief.