North Carolina Expands Medicaid to 600,000 Individuals

North Carolina Gov. Roy Cooper in Raleigh, N.C., on June 2, 2020. (Ethan Hyman/The News & Observer via AP)

North Carolina Gov. Roy Cooper signed a law on Monday to expand Medicaid eligibility to over half a million people whose higher level of income disqualifies them from traditional coverage.

Cooper, who has emphasized the need to address this issue since he was first elected in 2016, signed the “Access to Healthcare Options” bill into law at an Executive Mansion ceremony with a large audience.

“Medicaid expansion is a once-in-a-generation investment that will strengthen our mental health system, boost our rural hospitals, support working families, and so much more,” Cooper said in a statement. “This is a historic step toward a healthier North Carolina that will bring people the opportunity of better health and a better life.”

The new law is expected to expand taxpayer-funded health coverage for approximately 600,000 adults in North Carolina who earn more than the qualifying limit for traditional Medicaid but not enough to receive heavily subsidized private insurance.

The people who typically fall into the health care coverage gap include veterans, early childhood educators, restaurant workers, and nursing home workers. These individuals may have to work multiple jobs to afford health care.

Additionally, under the new law, North Carolina will receive billions of dollars annually from the federal government.

The bill’s passage comes after Democrats managed to convince Republicans to support the measure after years of pushback. The Republican-controlled legislature had for years rejected expanding Medicaid, an idea that originated from the 2010 Affordable Care Act.

In fact, the Republican lawmakers previously sued Cooper in federal court to prevent the expansion from moving forward, leading to budget impasses between them.

North Carolina was one of 11 states that didn’t accept Medicaid expansion from the federal government. However, some Republican-led states have recently reconsidered their stance on this issue.

The state has 2.95 million Medicaid enrollees but many people fall into a health care coverage gap and are unable to access treatment for preventable illnesses. Cooper called the law a crucial milestone towards improving the overall health of the state of North Carolina.

Republican Support

The new law contains a provision that Cooper opposed, which mandates that a separate state budget law be passed before Medicaid expansion can be accepted and implemented.

This provision makes it uncertain when the enrollment process will begin and gives the Republican party an advantage in upcoming negotiations.

“While a solution sat just out of reach, with this law I’m about to sign, many of them will be close enough to grab it,” Cooper said, standing next to House Speaker Tim Moore, Senate leader Phil Berger, both Republicans, as well as other expansion supporters.

The two legislators earlier this month finalized a negotiated agreement that contains expansion and looser “certificate of need” regulations on health care facilities before they can open more beds or use expensive equipment.

The House and Senate approved the deal separately, with the final vote happening Thursday.

GOP leaders have changed their minds recently, convinced that the state’s Medicaid program was fiscally sound with a switch to managed care and that Congress would neither repeal the 2010 law nor raise the state’s 10 percent required share of expenses.

“Now we have a Medicaid system that is stable,” Berger said. “By transforming our state’s Medicaid program, we’re now in a place where our system can handle those additional enrollees.”

Republicans also were attracted to an additional two-year $1.75 billion payout for North Carolina from the federal government if it expanded Medicaid.

The Associated Press contributed to this report.