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Tag: Medicaid

  • NC Senate Republicans float Medicaid expansion bill

    NC Senate Republicans float Medicaid expansion bill

    By Rose Hoban and Rachel Crumpler

    It finally happened.

    In a move that many health care advocates have been pushing for years, the state Senate introduced a bill on Wednesday that would expand the state’s Medicaid program to some half million-plus low-income North Carolinians.

    Until this point, Medicaid has been reserved mostly for children from low-income families along with a small number of parents in those families, poor seniors and people with disabilities. Since 2012, the possibility to sweep in many low-income workers has been on the table as a result of the Affordable Care Act, but Republican leaders in the state senate have been staunch opponents. 

    Now, after years of saying no, powerful Republicans in the state Senate are saying yes.

    “Why now? Why this? First, we need coverage in North Carolina for the working poor,” said state Senate leader Phil Berger (R-Eden), who admitted during a press conference Wednesday that he has likely been the most outspoken person in the state about his opposition to Medicaid expansion.

    “Second, there is no fiscal risk to the state budget moving forward with this proposal,” Berger added, noting that the bill includes pay-fors that would have hospitals largely on the hook to pay the 10 percent of the costs for the expansion population not covered by an enhanced federal payment. There’s also a federal incentive that would total some $1.5 billion in extra funds that would flow to North Carolina over a two-year period.

    Finally, he argued that since the state has moved Medicaid from being a state-run fee-for-service program to one managed by commercial insurance companies, the program has been “reformed and transformed.” 

    “Medicaid expansion has now evolved to a point that it is good state fiscal policy,” Berger continued. “But again, I cannot emphasize this enough: Expanding Medicaid needs to happen with additional reforms.”

    Those reforms could make the bill to be titled Expanding Access to Healthcare in North Carolina a hard pill for many to swallow. One aspect of the bill would set up a work requirement for the new beneficiaries, something that’s been repeatedly struck down in other states by federal judges. 

    What really might jeopardize passage of the bill is that it contains provisions that already are raising hackles in some powerful health care lobbies, including those that advocate for the state’s physicians and hospitals. 

    Resistance from doctors

    One reform proposed in the 33-page bill would make it possible for advanced practice nurses such as nurse practitioners, nurse midwives and certified registered nurse anesthetists (CRNAs) to practice without having a contract with a physician for their supervision.

    Physician and nursing groups have been divided over the so-called SAVE Act for years, with medical providers — led by the North Carolina Medical Society — usually being able to stop the nurses from having more leeway in their practices. At a Senate Health Care Committee hearing held after the press conference, several Democratic lawmakers also expressed reservations over this part of the bill. 

    Chip Baggett, head of the North Carolina Medical Society, also spoke out about the nursing practice language in the bill at the committee. He had a number of problems with the changes.

    “The first is the foundational education that is received by APRNs, many of which are receiving online education right now, and we do not think that provides the foundation necessary for independent decision making,” Baggett added after the meeting.

    Several decades of research, though, bolster the nurses’ contention that their practices are safe, and that patient satisfaction with advanced practice nurses is often better than for physicians.

    Joyce Krawiec, a Republican state senator from Kernersville, noted that 137 health care facilities across North Carolina only have CRNAs to deliver anesthesia services and that 34 other states have already loosened the rules around nursing practice.

    “My husband had a colonoscopy recently, and they can do it with the supervision of a physician,” Krawiec said. She recounted how she asked the physician leading the procedure if he was overseeing the anesthesia. He responded, “Heavens, no, I don’t supervise her. He said I haven’t looked at anesthesiology since I was in medical school. I wouldn’t know what to do. She does it all on her own.”

    Sen. Ralph Hise (R-Spruce Pine) argued that making it easier for nurses to practice, particularly in rural burgs, needed to be included in any bill that would make it easier for more people to see those providers. 

    “Finding nurses in this state is becoming more and more impossible,” Hise said. “And so this bill, allowing the nursing profession to expand its scope, to have more upward mobility in the nursing program is what ultimately I think will allow us to provide a lot of health care that we currently just don’t do.”

    Rep. Gale Adcock (D-Cary), who is also a nurse practitioner, said that increasing access to health insurance would require adding providers. 

    “The majority of folks clearly understand these things all need to happen at the same time, and I’m excited to see that it might happen soon,” she said.

    Hospitals, House objecting?

    One of the big obstacles to Medicaid expansion that Republican lawmakers have raised for years has been where the 10 percent of the expansion cost not covered by the federal government would come from. For years, lawmakers have argued that hospitals would be the main beneficiaries of more federal dollars for Medicaid flowing to the state, so hospitals could foot much of the bill in the form of an additional assessment.

    Hospitals have said they lose so much on uninsured patients that they were willing to pay for some of the cost, but not the whole tab. In Medicaid expansion bills in other years, this cost was also borne by a new tax on commercial managed care companies providing coverage under the “transformed” Medicaid program.

    Rep. Tim Moore (R-Kings Mountain), speaker of the North Carolina House of Representatives, told reporters on Wednesday afternoon that he didn’t think members of his caucus had an appetite for Medicaid expansion this year. Photo credit: Rachel Crumpler

    Hise contended the proposal will definitely help hospitals’ bottom lines, with more federal money flowing into the health care systems than they’ll have to put out to cover the rest of the Medicaid expansion population.

    A spokesman from the NC Healthcare Association, which represents the state’s hospitals, told NC Health News that his organization was reviewing the new bill and would wait to offer comment on its potential impact.

    The other big obstacle to passage of the bill may come from the other side of the General Assembly building in Raleigh, in the House of Representatives. Leaders there have expressed hesitation about making such a big policy change during this year’s short legislative session. 

    “The position of the House is we have no plans to take up expansion in the short session,” Rep. Donny Lambeth (R-Winston-Salem) said in a text to NC Health News. 

    Lambeth has been leading a committee with members from the House and Senate since January that has been examining what it would mean for the state to expand Medicaid. 

    “The work of the committee has not been finished and the committee has made no recommendations,” Lambeth continued. 

    The line from Lambeth and others on the House side has been that they’d rather come back for a special session on health care access in the fall. That, however, has drawn misgivings from state health leaders.

    “I mean, September sounds nice,” Health and Human Services Sec. Kody Kinsley said last week. “But here’s why I’m worried. First and foremost, this $1.5 billion dollar signing bonus that’s on the table right now. Right now, the money that is earmarked for North Carolina is nothing more than, you know, some print on a piece of paper. And it would not be hard for Congress to take that off the table, so they can invest it in other things they need to invest in. We cannot wait.”

  • Ohio could soon be kicking people off Medicaid. Here’s how to stay on

    Ohio could soon be kicking people off Medicaid. Here’s how to stay on

    Ohio could soon be kicking people off Medicaid. Here’s how to stay on

    Additional than 3 million very low-income and/or disabled Ohioans count on government-paid health insurance policies in the sort of Medicaid. Considering that the COVID-19 pandemic started, the federal authorities prevented any individual from remaining taken off from the application, but that could end shortly. 

    In July, the federal authorities could conclusion its COVID-19 unexpected emergency declaration. An understaffed and underfunded county-primarily based process would then have to comb through the overall Medicaid populace, redetermine everyone’s eligibility and take away ineligible men and women.

    Advocates say it truly is a scenario inclined to blunders, especially supplied a 90-working day timeline counties have to comply with. 

    Medicaid in Ohio: Extra than 400,000 Ohioans at risk of dropping Medicaid coverage this summertime as COVID crisis ends

    A ton of details are nonetheless unclear as Ohio waits for even further federal direction. But if you’ve got been on Medicaid at all all through the pandemic, here’s some methods you can take to make absolutely sure you really don’t get eradicated from the technique by blunder:

  • Pandemic uncertainty complicates Medicaid budget

    Pandemic uncertainty complicates Medicaid budget

    By Rose Hoban

    What a difference a decade can make.

    Republican lawmakers raised a ruckus 10 years ago when officials from the state Department of Health and Human Services informed them that North Carolina had spent millions of dollars more than projected on the Medicaid budget.

    But this month, when Dave Richard, the DHHS head of Medicaid, informed state lawmakers at a Joint Legislative Oversight Committee on Medicaid and NC Health Choice that Medicaid expenses were running higher than expected for the fiscal year ending in June, no similar outcry occurred.

    That shortfall in a $4 billion budget could top $100 million, Richard projected. Though it’s a small percentage of the overall budget, the dollar figure can be eye-popping, nonetheless.

    There are many reasons for the extra expense, including the pandemic and all the unexpected and related health care costs.

    In the spring of 2020, as historic questions about the pandemic loomed, Congress took huge steps to do away with barriers to treatment for the novel coronavirus.

    Republicans and Democrats pushed aside the hyper-partisanship that often plunges big bills and critical issues into a quagmire. Unaware of what lay ahead for the next two years, Congress came together to adopt the $2 trillion  CARES Act.

    Pandemic beneficiaries

    Tucked into the massive relief bill was a measure forbidding states from removing people from Medicaid rolls if they had suddenly qualified for the benefit because of job loss or other reasons during the pandemic.

    That applies throughout the duration of the public health emergency. No beneficiaries can be removed from Medicaid rolls until the end of the month in which the emergency expires.

    Usually, low-income workers in North Carolina don’t qualify for Medicaid. Most enrollees are children whose families barely make a living wage, people with disabilities and elderly people with little to no built-up wealth.

    In North Carolina, however, some low-income parents with children younger than 18 can be enrolled in the program for as long as their child qualifies. 

    The number of Medicaid beneficiaries in North Carolina more than doubled from March 2020 to this month, according to Richard. There were about 205,000 adult beneficiaries in March 2020. Now there are nearly 418,000 adults on the Medicaid rolls.

    More children qualified too, but since most children in the state already had some form of health insurance — whether Medicaid or otherwise — that part of the program hasn’t had the same rapid growth. 

    Monthly Medicaid enrollment growth since start of public health emergency. Image, data: NC DHHS

    All those extra people added to the program’s cost, Richard told lawmakers, leading to the news that Medicaid would be over budget for the first time in years.

    “The forecast was much more difficult because we were doing this in the middle of a pandemic,” Richard said. “And we were moving into managed care.”

    Nine months ago, the state changed how its Medicaid system was administered, moving from an in-house, fee-for-service program to a system run by large commercial managed care companies.

    Republican lawmakers pushed for the change not long after making political noise about the budget overrun in 2012, claiming mismanagement of the system after the Medicaid expenses outpaced what had been budgeted.

    When Richard updated lawmakers this month on the Medicaid budget, he said North Carolina had spent about 67 percent of its Medicaid budget. At this point in last year’s spending cycle, the program had spent 64 percent of its budget.

    “There are certain things … we didn’t recognize,” Richard said. “The enrollment projections are higher than we thought we would be.”

    “We thought at some point, this would even off quicker than it did,” Richard added. 

    Still in emergency mode

    Not only did North Carolina see its Medicaid beneficiary numbers explode, the federal and state government allowed rate hikes for health care providers during the pandemic.

    While the federal government pays an enhanced rate of more than 72 percent of the state’s Medicaid costs currently, there are still expenses that the state has had to bear. 

    Skilled nursing facilities got a bump up in rates to help them hire more personnel. Hospitals got a rate hike to help them cover the costs of personal protective equipment, staffing and long hospital stays by uninsured COVID patients. There also were extra costs for just about everything related to the pandemic.

    “We did do a lot of those COVID temporary rate increases that we’ve talked about,” Richard said. “And they stayed on longer than we planned.”

    Nonetheless, Richard assured lawmakers that he was confident that the spending trends were “going the right direction.”

    One reason for his confidence is that there are also one-time federal pandemic funds still sloshing around in the state budget to cover gaps that might arise because of the pandemic. 

    Another reason for his confidence was that NC public health officials thought at the time that the end of the federal public health emergency was to occur in the middle of April.

    During a pandemic with so many curves, many know to expect the unexpected.

    On the same day that Richard met with state lawmakers, federal Health and Human Services Secretary Xavier Becerra pushed the end out to mid-July, meaning that the bumped-up rates and the extra people would remain on North Carolina’s Medicaid balance sheets for an additional 90 days. 

    ‘Forecasts are always wrong’

    A decade ago, Medicaid was over budget for several years in a row and Republican lawmakers roundly criticized the program as wasteful. 

    This year, criticism of cost overruns has been muted, if there at all. 

  • Medicaid winds down coverage for PT & OT telehealth

    Medicaid winds down coverage for PT & OT telehealth


    By Clarissa Donnelly-DeRoven

    Before the pandemic, Valerie Fox almost never used telehealth — nobody did at the Veterans Affairs Medical Center in Durham, where she works as a behavioral health occupational therapist.

    Now, many patients request it. 

    “Especially with the VA, a lot of people come from a lot of different parts of the state to here,” Fox said. “When we go to transition to outpatient work, it’s a lot easier.” With telehealth, people can more easily incorporate OT into their daily schedules — an hour here, an hour there. 

    “It doesn’t become this big thing,” she said. 

    But that’ll likely be changing soon. By July 1, North Carolina Medicaid will no longer cover occupational and physical therapy services done via telehealth — and getting to and from appointments will become, yet again, a big thing. The change was supposed to take place March 31, but the state extended coverage for 90 more days. 

    Kimberly Godwin, the advocacy chair at the state’s occupational therapy association, has been getting a lot of emails over the last few months from therapists such as Fox telling her how telehealth has helped them serve more clients. 

    “We’ve heard from a lot of businesses within the pediatric as well as other outpatient settings or specialized care, like mobility clinics, that have been able to just really broadly reach clients,” she said. “There’s been less cancellations, less no shows.” 

    Many providers have noted how telehealth increased access for people who can’t afford transportation to and from a clinic, or those who don’t have any transportation to begin with. 

    Even the state’s Medicaid program sounds supportive of keeping telehealth for physical and occupational therapy. 

    Data from the North Carolina Department of Health and Human Services shows that claims from people on Medicaid for telehealth services hit their height at the start of the pandemic, and have declined since. Credit: NCDHHS.

    “Over the past two years, telehealth flexibilities helped children and families access valuable PT/OT services during the unprecedented circumstances of the COVID-19 pandemic,” said state health department spokesperson Catie Armstrong. 

    But she said that right now, the federal Centers for Medicare & Medicaid Services is not allowing any permanent changes to telehealth services. During the first few months of the public health emergency, the state recorded nearly 60,000 telehealth claims from people on Medicaid. In the months since, that number has declined.

    That means, even if it wanted to, North Carolina doesn’t have the authority to permanently authorize the state Medicaid program to cover virtual OT and PT services. The coverage rollback has left many who work in the field worried about the impact it will have on people across the state, especially those in rural areas. 

    Unique role telehealth plays in OT and PT

    Since the start of the pandemic, researchers at Duke University have been investigating the role telehealth plays in expanding access to care in general. One study is examining the impact virtual care has had for people receiving OT and PT. 

    Katherine Norman, a pediatric occupational therapist, is one of the investigators on the study.

    “The population we looked at was children and adolescents, so that was anybody from zero to 20, enrolled in Medicaid from April 2020 to March 2021,” she said. The researchers analyzed the Medicaid claims data of about 137,000 children with a musculoskeletal health diagnosis who visited a provider during the time period. 

    “The data that we uncovered really suggests that removing access via telehealth could impact as many as one in five kids who were using physical therapy and one in three kids who are using occupational therapy,” Norman said. To add a qualitative dimension to their study, the researchers are also speaking with people on Medicaid, health care providers, and community leaders statewide.

    Physical and occupational therapy can be critical for helping kids meet developmental milestones. PT can help children learn how to do critical physical tasks with more ease: walk and run, get on and off the floor, and play, while OT helps kids with the development of fine motor skills, such as brushing their teeth or holding a comb. 

    Imagining all those kids missing out on this kind of care deeply worries Norman. 

    Also, she says, telehealth holds a unique value within occupational therapy because of the nature of the care. If she’s seeing a patient, rather than just telling her about the stairs they have trouble climbing, or the corner they want to be able to stand behind to surprise their sibling, they can literally bring her into the room.

    “They can show me exactly how they do it,” she said, “so that I can see that and be like, ‘OK, so we need to work on your ability to crouch, or your ability to jump, or [whatever] specific movement pattern.’”

    Fox agrees. 

    In OT, “We think a lot about the environment, and how that impacts function and somebody’s ability to participate,” she said. “When it comes to having somebody leave their natural environment to come to an outpatient clinic, you have to ask a lot of questions: What does your home look like? And how do you move through your home? And what is the environment?

    “Telehealth allows you to truly see that in the moment and kind of be there with someone and I think that’s another layer, in addition to accessibility.”

    Also, Fox says, it doesn’t have to be all or nothing. In a perfect world, care going forward could be a blend of telehealth and in-person care. 

    “I just had that with a veteran,” she said. “He’s 75. He lives about an hour and a half away. So the first visit was that we do a lot of assessments, and now that we kind of know each other and I have more of an idea of his level of function, the next few sessions could be telehealth.”

    “What is the harm in keeping it as an option?” 

    Fox, who in addition to her full-time job at the VA is also the president of the North Carolina Occupational Therapy Association, said she was unaware of any outreach the state health department had done to ask occupational and physical therapists how virtual coverage was going for them and if they’d want it to continue going forward. 

    “This came to our attention when we were informed of the date of the sunset,” Fox said. Medicaid refers to the end of coverage for certain services as ‘sunsetting.’ 

    “So, we did not realize that this was coming, and definitely not that it was coming as fast as it was,” she said. “We’ve been told that they did not have the data showing that the telehealth modality was utilized enough. We are unclear on what type of data that was, or how it was collected or what their cutoff is for ‘enough,’ but that was what we’ve been told so far.”

    Spokespeople from DHHS did not directly answer the question of if they conducted outreach to providers, but said that they have qualitative data from families showing support for telehealth. Still, they said, the data the department has collected and analyzed “did not demonstrate the use of these services.”

    In a public webinar presentation on March 17, the associate director of program evaluations at North Carolina Medicaid, Sam Thompson, presented the data collected by Norman and the other Duke researchers, but came to a different conclusion than the researchers.

    “As a proportion of care, telehealth is just substantially lower in this group,” he said. “Because it’s such a small proportion of care, it’s a little bit less meaningful”

    But, Fox argues, even if utilization rates were low, if anyone used it, it’s worth keeping. 

    “It’s about access,” she said. “And so if five people throughout the year use it, what is the harm in keeping it as an option?” 

    Data collected by researchers at Duke University that NC Medicaid officials presented at the end of March. Though Thompson said utilization of these services was proportionally small, NCDHHS extended temporary Medicaid coverage of tele-OT and tele-PT services after the presentation. Credit: NCDHHS; Duke University.

    The state Medicaid office did worry at first that adding telehealth as an option would increase costs, but that’s not what they’ve seen. 

    “We have not found it to be significantly more expensive,” Thompson said. “We have some evidence to suggest that it can help prevent complicating factors that might be more expensive.”

    It’s unclear if private insurance plans will continue to cover tele-OT and PT or sunset their coverage as well. But historically, Godwin said, private insurance plans often follow what Medicaid does, meaning there’s a good chance that if telehealth for OT and PT is made permanent by the federally funded health care program, other insurance plans may follow. 

    While the state Medicaid office is limited in its ability to make permanent changes to its telehealth coverage policy, providers spoken to for this story want to encourage officials to do everything they can to make sure the coverage remains permanent. 

    If it goes away, they argue, fewer people will get the care they need. 

    “And that makes me really sad,” Godwin said.

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  • Postpartum Medicaid to be extended to one year

    Postpartum Medicaid to be extended to one year



    By Elizabeth Thompson

    Postpartum Medicaid will be extended from 60 days immediately after beginning to a single yr starting up now, as a provision involved in previous year’s condition spending budget comes into impact.

    The provision permits expecting people at or below 196 p.c of the federal poverty pointers – about $34,800 for a family of two – to stay suitable for protection for 12 months postpartum.

    Medicaid protection for expecting folks experienced beforehand ended about two months after offering start, even however quite a few pregnancy-associated deaths arise 43 to 365 times postpartum, in accordance to the Facilities for Ailment Control and Prevention. 

    North Carolina has a maternal mortality level of 21.9 fatalities for every 100,000 are living births in accordance to the yearly America’s Overall health Rankings report, which utilizes CDC info. The United States averages 20.1 maternal fatalities for every 100,000 are living births.

    “This prolonged protection is an essential ingredient to assist boost the wellbeing of family members in our state,” Deputy Secretary for North Carolina Medicaid Dave Richard explained in a push launch. “I hope we can construct on this significant action by expanding Medicaid in North Carolina to additional support maternal wellbeing and cut down toddler mortality by enhancing health and fitness before the pregnancy.”

    Sarah Verbiest, a member of the NC Kid Fatality Task Pressure known as the provision “a activity changer for new families in North Carolina” ahead of the legislation was handed, at the group’s Perinatal Wellbeing Committee meeting in late September.

    North Carolina for Better Medicaid claimed the go “​​has the possible to make a significant variance in the wellbeing of new mothers and their households,” in a push launch in December.

    What it means

    The extended protection applies to all categories of beneficiaries, according to the North Carolina Division of Wellness and Human Services. Those people who are qualified for postpartum Medicaid will acquire a letter detailing the alter, in accordance to NC DHHS.

    The change will come after the postpartum Medicaid gains for folks who gave start through the pandemic have continued for months past the 60-working day reduce off thanks to a provision in the Families Initial Coronavirus Reaction Act, which proceeds to cover new moms and dads until the conclude of the federal COVID general public health emergency, which is now because of to expire on April 16.

    The American Rescue Strategy Act of 2021 gave states the potential and the income to prolong postpartum coverage to 12 months, which the North Carolina Basic Assembly incorporated in its spending plan which passed in November 2021 at a value of $12.5 million in condition pounds in the current fiscal yr (which finishes on June 30) and a further $50.8 million in point out money in the coming fiscal year.

    Beginning April 1, pregnant folks on Medicaid for Expecting Girls will have protection for entire Medicaid benefits, this means they will also have coverage for providers these types of as dental, doctor’s visits, vision and behavioral wellness care. A whole checklist of Medicaid products and services can be located listed here.

    Advocates say the extension is critical since a lot of postpartum deaths are because of to preventable leads to, these kinds of as compound use disorder, cardiac ailment or dying by suicide, in accordance to the American School of Obstetricians and Gynecologists. 

    About 12 per cent of females in North Carolina working experience postpartum melancholy, in accordance to NC DHHS.

    New dad and mom can be vulnerable in the initial months immediately after providing delivery and may well go through from health disorders from physical wellbeing concerns to mental wellness struggles, Verbiest previously instructed NC Overall health News. 

    Advocates for women’s well being have argued that extending postpartum Medicaid can assistance minimize deaths that arise outside the house of the 60-working day window North Carolina experienced earlier utilised for postpartum Medicaid, primarily since 41 per cent of births in North Carolina are financed by Medicaid, in accordance to Kaiser Family members Foundation.

    Extension not expansion

    Even though the condition has extended Medicaid for expecting people, it has nonetheless to develop Medicaid for the remainder of small-earnings adults. Currently, the Tar Heel condition is one of just 12 states that has not expanded Medicaid, some thing that turned feasible due to the fact of the Cost-effective Treatment Act. Even so, a bipartisan committee at the state Legislature is studying the probability of increasing Medicaid.

    Medicaid expansion has divided North Carolina’s legislature along party lines for virtually a 10 years, with Democrats, like Gov. Roy Cooper, mainly supporting enlargement and Republicans mostly opposing it.

    38 states plus the District of Columbia have chosen Medicaid expansion since it became an option in late 2012.
    North Carolina is a person of 12 states that has not picked out Medicaid growth due to the fact the plan was manufactured accessible as a outcome of the Affordable Care Act in late 2012. Map, information: Kaiser Family Foundation

    Medicaid enlargement would allow households with an cash flow underneath 133 p.c of the federal poverty line to qualify for protection. Now, only lower-money employees, reduced-money persons with small children, people today with disabilities and pregnant persons qualify up till they give start and for 60 days thereafter.

    Extending postpartum Medicaid was a bipartisan effort. It was originally launched as a Senate monthly bill by three Republican Sens. Jim Burgin (R-Angier), Joyce Krawiec (R-Kernersville) and Kevin Corbin (R-Franklin). 

    Both of those Krawiec and Corbin are on the Medicaid enlargement committee. Corbin has been a vocal supporter of expanding Medicaid.

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  • Is this the year NC gets Medicaid expansion?

    Is this the year NC gets Medicaid expansion?


    By Anne Blythe

    The state Legislative Building designed by architect Edward Durell Stone almost 60 years ago has a maze of hallways where lawmakers often buttonhole each other for private discussions about contentious public issues.

    Rep. Donny Lambeth (R-Winston-Salem) is one of those lawmakers who has been taken aside recently to discuss the pros and cons of expanding Medicaid in North Carolina.

    “One of the hallway conversations always comes around to, ‘Well so and so state has had all kinds of financial problems because they expanded Medicaid’  … so I really want to understand what has been the experience in other states as far as balancing their budgets, the impact on their operating funds and pressure it puts on their operating funds because they expanded,” Lambeth said Friday at the first meeting of the Joint Legislative Committee on Access to Healthcare and Medicaid Expansion.

    While lawmakers from both parties have talked about ways to expand health care access for a while, there seems to be more momentum behind the joint House and Senate committee whose charge grew from budget negotiations last year with Democratic Gov. Roy Cooper, an expansion advocate. 

    Rep. Donny Lambeth (R-Winston-Salem) discussed some of the structural issues with Medicaid that the legislature has addressed over the past few years during a press conference at the NC General Assembly in 2019. Photo credit: Emily Davis

    The new panel of lawmakers met for the first time on Friday to probe how to provide health care coverage to some 500,000 low-income adults who could have access to Medicaid if North Carolina joined 38 other states and expanded the program as the Affordable Care Act has allowed since 2013.

    Through much of the past decade, Medicaid expansion has been a thorny topic that has divided Democrats, who support it, and Republicans who have resisted adding more North Carolinians to the subsidized government health insurance program. More recently, some Republicans including Senate Leader Phil Berger (R-Eden) have warmed up to the idea, recognizing a need to close the insurance gap in the state. 

    Dispelling misinformation

    The federal government subsidizes 90 percent of the cost for adults enrolled through the ACA expansion. The American Rescue Plan Act of 2021 provides additional financial incentive for the 12 states that have yet to approve expansion, allowing them to temporarily draw down additional federal funds. 

    The National Conference of State Legislatures estimates North Carolina could get an additional $1.5 billion to $2 billion in additional federal funding. Kate Blackman, NCSL health director, and Emily Blanford, NCSL program principal, presented a report to the legislators on Friday with specifics on North Carolina and an overview of what other states have done.

    Lambeth told Blanford about another hallway conversation he’s had, one that many Republicans have echoed as they explained their financial worries about expanding Medicaid. They worry the federal government will shift the fiscal burden to the state by decreasing its percentage of funding either abruptly or over time.

    “The second part of that financial piece — you know, hallway conversations — is ‘Well, you know they started at 100 percent, that rate dropped to 90. What prevents them from going down to 70 or 60 or 50, and pull the rug out from under us and put more pressure on our state budget because all of a sudden now we’ve done it. It’s hard to take away a benefit, and we’re just going to have to pay more because you know, they kind of pulled that rug out from under us on that 90 percent,’ ” Lambeth said. “What does the law say about the 90 percent and how would that percent be changed?”

    The federal government’s commitment to providing states with 90 percent of the expansion cost is written into the Social Security Act, Blanford responded, so it would take an act of Congress to change the law.

    Lambeth explained after the meeting that he was trying to get answers throughout the two-and-a-half-hour discussion to dispel misinformation he’d heard from legislators who often stopped him in the corridors because they knew he was co-chair of the new committee.

    Chilly caucus

    Though some longtime critics of expansion have warmed to the idea during the coronavirus pandemic, such as the powerful leader of the Senate, there still are staunch opponents, especially in the state House.

    “We’re not lukewarm in the House,” Lambeth told reporters after the meeting. “It is still rather chilly. It is a heavy lift to convince our House caucus that this is the right direction to go. Now is it impossible? No. I wouldn’t be here if I thought it was impossible.”

    The committee touched on a wide range of health care topics Friday. The lawmakers discussed how to rein in the surprise medical bills that insured people get after inadvertently receiving care from an out-of-network provider they did not choose. They also discussed the shortage of nurses and other health care providers already hampering the state and how to help struggling rural hospitals and expand care access in those areas.

    The next meeting of the Medicaid expansion committee is set for March 1.

    ‘The health care session’

    The coronavirus pandemic has exposed under-funded health care systems and a lack of convenient access to quality care for numerous North Carolinians, many who live in some of the more rural districts represented by Republicans.

    Lambeth said he expected the committee to spend months fact-finding and creating recommendations for what he called a “North Carolina plan” that could be ready in August or September and perhaps put to a full General Assembly vote by October. That could be a politically charged vote before the November elections.

    That plan might expand Medicaid or subsidized coverage to hundreds of thousands of North Carolinians without specifically calling it “Medicaid expansion.”

    “I can sort of view this as the health care session,” Lambeth said.

    Sen. Kevin Corbin (R-Franklin), a committee member, is interested in exploring an array of programs that he has heard other states have used. “The view from 130,000 feet is we have a large number of uninsured people,” he told reporters after the meeting. “We need to get those people insured. How to do that is the question.”

    “Medicaid expansion” used to be a bad word in some corridors of the Legislative Building, he said. “I think it has been, but I think it’s not so much anymore,” Corbin said.

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