Updated Mar 3, 2023 - News

North Carolina Republicans reach agreement to expand Medicaid

Illustration of people shaking hands with pill bottles as sleeves.

Illustration: Shoshana Gordon/Axios

After more than a decade of blocking North Carolina from expanding Medicaid to hundreds of thousands of the state's working poor, the legislature's Republican leaders reached a deal on a plan to do so, they announced Thursday.

Why it matters: The agreement between Senate leader Phil Berger and House Speaker Tim Moore is a signal that the long-awaited legislation is almost certain to become law this year.

  • "This bill will help give hundreds of thousands more North Carolinians the chance to live healthy lives," Dave Almeida, senior director of government affairs at The Leukemia & Lymphoma Society, said in a statement. "That’s enormously powerful.”

State of play: Berger and Moore's announcement comes just eight months after negotiations between the pair over what health care regulatory measures to package with Medicaid expansion fell apart.

  • The joint proposal, which has received the blessing of Democratic Gov. Roy Cooper and the state's hospital association, would significantly reform the state's certificate-of-need laws, which requires government approval for health care facilities and services.

The big picture: North Carolina is one of just 12 states that has yet to expand Medicaid under the Affordable Care Act.

  • If the bill becomes law, in addition to expanding health care to around 600,000 North Carolinians, the state is expected to receive an estimated $8 billion annually, according to DHHS.

Flashback: The prospects of Medicaid expansion's passage under Republican legislative leadership became more likely than ever last May, when Berger reversed his position that expansion is bad policy and introduced a bill to grant Medicaid coverage to an additional 600,000 North Carolinians.

  • "If there is a person that has spoken out more against Medicaid expansion than I have, I’d like to meet that person," Berger said at the time. "In fact, I'd like to talk to that person about why my view on this has changed."
  • In the final hours of the legislative session last July, the two chambers scrambled to work out a deal.

Details: This year's proposal includes a partial repeal of certificate-of-need laws, which restricts the unnecessary duplication of medical facilities and serves, eliminating the requirement for behavioral health beds, along with some ambulatory surgical centers, diagnostic centers and MRIs.

Between the lines: The current draft also specifies that Medicaid expansion would become effective only when Cooper signs the state budget into law, giving Republicans leverage to include measures in the budget that the governor might otherwise oppose.

  • In a statement Thursday, Cooper called for the legislature to make Medicaid expansion legislation effective immediately on becoming law.

What's next: The Senate will take up the proposal in the coming weeks, Berger said Thursday.

Editor's note: This story has been corrected to reflect that, if the bill becomes law, North Carolina is expected to receive around $8 billion (not $800 million) in annual payments.


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