A proposed state Medicaid expansion bill has been tweaked to delay the potential rollout and to definitively declare that the initiative would end if the federal government doesn’t keep its 90% funding pledge.

The tweaking also severs House Bill 655 from the state budget compromise, which awaits a veto override vote in the Senate after a successful and highly controversial override passage in the House on Sept. 11.

The current version of HB655 said its implementation is contingent on the state budget becoming law first.

The latest version of HB655 is scheduled to be heard at 9 a.m. today by the House Health committee, which has bill author Rep. Donny Lambeth, R-Forsyth, as one of its co-chairs.

The current rollout plan was for July 1, 2020. The bill would now delay that by six months. The effective date would be 120 days after the Centers for Medicare & Medicaid Services approves the expansion waiver.

The bipartisan bill has proven controversial because it contains two elements key to expansion in Republican states: a work or community volunteer requirement for some recipients; and a requirement that recipients pay 2% of their monthly household income for Medicaid coverage. The proposed version of HB655 retains those elements.

Those requirements have been held up by federal judges in at least three states.

HB655 has the potential to expanding Medicaid coverage in the state. Several studies have estimated that between 450,000 and 650,000 North Carolinians could be covered.

Democrats submitted 12 amendments to HB655 while it sat on the House calendar.

Lambeth said Tuesday that “we have incorporated several (of the amendments), and the balance will be heard in committee.”

“We are going to do committee work in the committee, not on the floor.”

House Speaker Tim Moore, R-Cleveland, withdrew the bill from the House calendar Sept. 11 — where it had sat since July 9 — and sent it back to the House committee at Lambeth’s request. Moore said he was committed to conducting a vote on HB655.

Senate Republican leadership, foremost Senate leader Phil Berger, R-Rockingham, oppose HB655, in large part because of its dependence on federal funding and its reliance on an annual $758 million assessment from the state’s hospitals and healthcare systems.

The latest version, according to a legislative staff analysis made public Tuesday, would state that “if any program component cannot be implemented, then coverage will not be provided” until that occurs.

If the federal government does not provide its 90% match for new administrative costs, the expansion would be terminated or not implemented under certain circumstances.

Those also include if the expansion program approved by the Centers for Disease Control and Prevention “does not substantially comply with the requirements of the bill, or if funding is inadequate.”

Since Democratic Gov. Roy Cooper vetoed the state budget compromise on June 28, Berger has claimed that Cooper is “holding the entire budget hostage” over Medicaid expansion that he says puts “able-bodied individuals” in front of disabled individuals for funding priorities. Medicaid expansion supporters say a significant number of potential beneficiaries are individuals and families who fall in the current coverage gap of making too much in household income to qualify now for Medicaid, but not enough to afford coverage on the federal health exchange.

For the 36 Medicaid expansion states and the District of Columbia, the federal government has been consistent even under the Trump administration in meeting its 90% contribution. Lambeth told a House committee in July that the 90% federal government match is sustainable and would take an act of Congress to change.

Medicaid already serves 2.14 million North Carolinians, representing about 21% of the state population.

Cooper has placed Medicaid expansion among his top-three legislative priorities, along with higher raises for public-school teachers and school construction, and halting the next round of corporate tax-rate cuts.

Most left-leaning advocate groups say that while they support Medicaid expansion, the work and premium requirements are too onerous overall compared with the potential benefit.

The bill adds immunizations to the list of preventive care and wellness activities covered by expansion.




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