North Carolina Senate Republicans to push for Medicaid expansion

After years of refusing to expand Medicaid in North Carolina, state Senate Republicans are expected to propose a measure to do so as early as this week, Axios has learned.

The legislation would also include a handful of measures that broaden health care access in North Carolina, numerous sources with knowledge of the bill said.

Why it matters: The proposal would expand health care coverage to hundreds of thousands of the state's poorest residents.

• Plus: Proposing such legislation would be a remarkable pivot, as North Carolina's most powerful Republican, Senate leader Phil Berger, has long opposed expanding Medicaid.
• Berger shifted his stance last year, when he signaled he was open to negotiating Medicaid expansion with Gov. Roy Cooper as part of the state's budget package. But he still maintained it was a bad policy.
• Senate Republicans' proposal is also surprising given that House Republicans — who proposed legislation expanding Medicaid in 2019 — said last year they don't believe they have the votes to pass it.

Details: The federal poverty level is $23,030 for a family of three. People who make less than 40% of that, about $10,000 a year, are eligible for Medicaid in North Carolina. The Affordable Care Act allows states to expand that to 138% of the FPL.

A legislative summary of the bill provided to Axios shows it would:

• Expand Medicaid coverage to some 600,000 non-elderly, non-disabled adult North Carolinians. Currently, more than 400,000 are on the Medicaid rolls, North Carolina Health News reported.
• Give advanced practice registered nurses the authority to practice without physician oversight. A majority of both Democratic and Republican lawmakers supported a version of the legislation proposed in 2021, but it stalled amid pushback from physicians.
• Change requirements for health care providers applying to open facilities

• Set rules for medical billing transparency
• Define telehealth

Yes, but: Lawmakers have been meeting for months to study Medicaid expansion and expanding access to health care with an end goal of proposing legislation.

• Until now, it's been unclear if they would advance a bill that included Medicaid expansion in this year's legislative session, which began last week.

What's next: The legislation still faces a steep uphill battle, as it will need to make its way through numerous committees and be approved by both the Senate and the House.

Democratic Senate minority leader Dan Blue expressed doubts that the legislation stands any chance.

• "The House is saying they're not going to take up Medicaid expansion," Blue told Axios. "I believe them."

Editor's note: This story was updated to clarify the current eligibility requirements for Medicaid in North Carolina.