North Carolina bipartisan agreement to expand Medicaid clears state Senate

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A bipartisan agreement to expand Medicaid coverage to more low-income adults while loosening or ending several regulatory hurdles to building more health care facilities could get its final votes next week after clearing the Senate on Wednesday.

Senators voted 44-2 to complete its approval of legislation that would direct state health officials to accept Medicaid coverage provided for in the Affordable Care Act. The margin was nearly identical to Tuesday's initial vote in the chamber.

The measure now moves to the House, where it will be voted on next week at the earliest, said Rep. Donny Lambeth, a Forsyth County Republican and negotiator on the expansion agreement between House and Senate Republicans two weeks ago.

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Roy Cooper, governor of North Carolina, speaks in Charlotte, North Carolina, on, July 21, 2022. Cooper is a longtime Medicaid expansion advocate. (Grant Baldwin/Bloomberg via Getty Images)

Speaker Tim Moore said House floor votes will resume next Wednesday.

The bill, once given final approval, will be sent to Democratic Gov. Roy Cooper, a longtime expansion advocate. Even if signed into law, expansion can't be enacted until a separate state budget law is approved in the months ahead, according to the bill language.

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North Carolina, currently with 2.9 million enrollees in traditional Medicaid coverage, is one of 11 states that haven’t yet adopted expansion. As many as 600,000 people ages 18-64 could receive such coverage.

The state's 10% share of expenses for Medicaid expansion recipients would be paid through hospital assessments. But hospitals also are expected to receive larger reimbursements for treating Medicaid patients through a federal program the state is requested to enter in the legislation.

The legislation also would scale back "certificate of need" rules that have required state health officials, for example, to sign off before hospital beds for mental health patients are opened or MRI machines are purchased.