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[MM Curator Summary]: Ruh roh. The journo says the quiet part out loud. Alternative summary: Cooper sees whats happening and asks pretty please for legislators to forfeit all leverage they have in this giant deal.
Gov. Roy Cooper urged state Republican legislative leaders to separate funding for Medicaid expansion from the 2023-24 state budget.
Allison Lee Isley, Journal
Gov. Roy Cooper urged state Republican legislative leaders on Monday to separate funding for Medicaid expansion from the 2023-24 state budget, even though that funding is those leaders’ primary leverage against a budget bill veto.
Cooper signed House Bill 76 into law on March 27, surrounded by a bipartisan group of state legislators, including bill sponsor Rep. Donny Lambeth, R-Forsyth.
The signing of HB76 means that between 450,000 and 650,000 North Carolinians are a step closer to having health coverage through Medicaid.
Yet, the expansion legislation has been stuck in limbo as Republican House and Senate budget negotiations have spilled over into July.
There are no new projections of when the 2023 regular session will end.
Without a signed state budget, the legislation in HB76 would expire on July 1, 2024, meaning North Carolina won’t become the 40th Medicaid expansion state.
Cooper said Monday that “making Medicaid expansion contingent on passing the budget was and is unnecessary.”
“Now, the failure of Republican legislators to pass the budget is ripping health care away from thousands of real people and costing our state and our hospitals millions of dollars.
“Tying it to the budget is tying our hands, and the legislature should decouple the two and start Medicaid expansion now.”
Legislative analysts have expressed concerns that Republican legislative leaders may insert controversial legislation into the budget, potentially causing Cooper not to sign it.
That would set up a potential veto override vote in both chambers.
Next steps
North Carolinians who would likely be eligible under an expanded program are those between the ages of 18 and 64 who earn too much to qualify for Medicaid coverage, but not enough to purchase coverage on the private insurance marketplace.
Once there is a signed 2023-24 state budget, the N.C. Department of Health and Human Services will submit a State Plan amendment to the federal Centers for Medicare and Medicaid Services.
“After a budget is enacted, we will determine a proposed go-live date,’ DHHS said Monday. “That is why the governor is seeking to separate the budget from our ability to go live.”
DHHS said on March 27 that “CMS has up to 90 days to review and approve the State Plan Amendment, or issue a Request for Additional Information that stops the 90-day clock.”
“When N.C. Medicaid submits a response to the Request for Additional Information, the 90-day clock for review and approval restarts.”
Medicaid expansion finally moved forward in March when the House chose to agree with the prominent Senate changes to HB76 that foremost addressed easing or eliminating several certificate-of-need provider restrictions.
Cooper acknowledged during a March 27 MSNBC interview the necessity of the CON reform measures, saying providing “more competition in the health care arena was incorporated into this final agreement.”
Lambeth focused on the economic impact of expansion, particularly the additional $1.7 billion in federal incentive funding coming to the state.
“These funds can be used for much-needed reform of our mental-health system, improving access to care sites across the state that provides care to our citizens when needed rather than being in one of our emergency rooms awaiting care,” Lambeth said.
“The impact of federal funds to North Carolina’s economy is $6 billion per year.”
Lapsing coverage
An accompanying statement from the governor’s office said that by not having a 2023-24 state budget in place, “this failure could result in more work for counties, less money for hospitals and people losing care in the interim for no reason.”
“If Medicaid Expansion and HASP (Healthcare Access and Stabilization Program that reimburses hospitals) don’t go live at the same time, it will cost the hospitals as much at $60 million more than necessary.”
The statement from the governor’s office stressed that about 9,000 people will lose their Medicaid coverage during July alone who would have been able to keep it under expansion.
There are estimates that nearly 300,000 North Carolinians receiving COVID-19 pandemic-related Medicaid coverage could face being removed as a recipient over the next 12 months.
However, NCDHHS said it is working “to ensure people eligible for Medicaid do not lose coverage, and those no longer eligible are transitioned smoothly to affordable health plans or other health care options.”
“Many of these beneficiaries will be eligible for health care coverage under Medicaid expansion, which the legislature recently passed, but cannot start until after CMS approves North Carolina’s changes and a (state) budget is enacted.”
NCDHHS said its goal during unwinding “is to ensure people who remain eligible for Medicaid continue to be covered and those who are no longer eligible know their potential options, such as buying coverage, often at a reduced cost, through the federal Health Insurance Marketplace.”
State Medicaid officials have been working with county Departments of Social Services and other partners to reach as many beneficiaries as possible “to explain what they can expect and their potential options to obtain health coverage.”
Beneficiaries have the right to appeal the decision by their local DSS, and information on this process is included in their notice of termination or reduced benefits.