Dive Brief:

  • Republicans in the North Carolina Senate have drafted legislation that would expand Medicaid coverage to an additional 600,000 low-income adults.
  • The proposal, called NC Health Works, marks a shift in sentiment for North Carolina’s Republican-controlled Senate chamber, more than a decade after the Affordable Care Act paved the way for states to expand Medicaid coverage to people whose household income is calculated at 138% of the federal poverty level.
  • North Carolina Senate leader Phil Berger has said he is willing to consider expansion because he no longer expects the federal government to discontinue paying 90% of the cost, according to an Associated Press report.

Dive Insight:

Enrollment in Medicaid surged during the COVID-19 pandemic, boosted by increased subsidies and other incentives. The federal safety net insurance program now covers nearly one in four Americans. 

All but 12 states have accepted federal funding to expand Medicaid under the ACA since its enactment in 2010. The latest to join, Oklahoma and Missouri, expanded eligibility last year, after voters approved ballot measures. Utah, Idaho and Nebraska adopted Medicaid expansion in 2020.

HHS data released last month showed that of the record 35.8 million Americans with health insurance under ACA provisions, about 21 million obtained their coverage due to Medicaid expansion. HHS Secretary Xavier Becerra has said the agency will continue to work to encourage holdout states to expand Medicaid. The American Rescue Plan, passed in March 2021, added more funds to entice states.

In North Carolina, where about 2.7 million residents are enrolled in Medicaid, that additional funding would give the state $1.5 billion over two years if it adopts expansion, according to the AP report.

North Carolina’s Democratic governor, Roy Cooper, has proposed expanding Medicaid in state budgets that the Republican-led legislature so far has failed to adopt. A bipartisan legislative committee was formed to look at Medicaid expansion.

The draft bill summary indicates the state would pay its 10% of Medicaid expansion costs through a new assessment on hospitals, and expansion would end if Congress increased the state’s share of the expense.

In addition to North Carolina, states that have not expanded Medicaid eligibility are Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, South Dakota, Tennessee, Texas, Wisconsin and Wyoming.

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North Carolina Republicans draft Medicaid expansion bill – Healthcare Dive