The Carolina Cares Medicaid expansion legislation was reintroduced Tuesday with the expectation of covering at least 543,000 North Carolinians, according to bill sponsors.
The legislation contained in House Bill 655 is now titled NC Health Care for Working Families.
The bill represents a second attempt by Rep. Donny Lambeth, R-Forsyth, at a bipartisan Medicaid plan for the state.
Senate leader Phil Berger, R-Rockingham, has been an adamant opponent of any expansion initiative.
Medicaid serves 2.14 million North Carolinians, representing about 21 percent of the state population. About 1.6 million will be enrolled in managed care under a federal waiver.
The proposed legislation retains two controversial elements: a work requirement for some Medicaid recipients between ages 19 and 64; and an assessment for health care systems and prepaid health plans (PHP) to pay for the state’s 10 percent share of additional administrative costs. Healthcare systems and PHPs would pay $758 million annually.
The federal government would pick up the remaining 90 percent.
Participants would be required to contribute up to 2 percent of their household income toward an annual premium, billed monthly, that would be paid to the PHP insurers. There are some exceptions to the requirement.
“There will be at least 300,000 individuals who will be covered by expansion, and another 200,000 who would find this as a viable, lower-cost health insurance option compared to what they are currently eligible for,” Lambeth said.
The 2017 version of the bill, House Bill 662, received bipartisan backing — reluctantly by some Democrats — as a potential moderate initial step toward expanding state Medicaid.
The bill, however, stalled in committee because of lack of GOP leadership support.
Lambeth acknowledged “it’s hard to tell” how much GOP leadership support the latest version will get. He said he has been having conversations with House Speaker Tim Moore, R-Cleveland, and is prepared to educate the Democratic and Republican caucuses on the societal value of the legislation.
It is possible the bill could be inserted into state budget negotiations. Lambeth is the House’s head budget writer.
Democratic Gov. Roy Cooper can veto any public bill if he has unanimous Democratic support in the Senate and no more than four Democratic defectors in the House.
Cooper’s budget plan recommends expanding Medicaid “to bring $4 billion into North Carolina’s economy, create an estimated 40,000 jobs and provide more affordable health care for 500,000 people,” according to a statement from his office.
The N.C. Healthcare Association said it supports HB655 “as a common-sense option” to close the coverage gap and increase affordable access to health insurance for working individuals and families in North Carolina.”
“Other states that have created expanded coverage options are already seeing significant improvements in health outcomes as a result,” said Steve Lawler, the association’s president.
The N.C. Medical Society said the legislation “is the right thing to do for hard-working, low-income North Carolina families who need access to care. We hope the General Assembly will take this up sooner rather than later.”
Advocacy group NC Child said it supported the bill "despite its shortcomings. ... It is a huge step forward. We want the best outcomes possible for North Carolina’s kids – and that means they need healthy parents who can take care of them."
Dr. Greg Murphy, R-Pitt, said he agreed to be a sponsor because of the potential for the Carolina Cares bill to play a positive role in resolving the state’s opioid problems.
Only one in every six individuals treated in a hospital emergency department for an opioid overdose has regular access to primary care or lack health insurance coverage, Murphy said.
Of those who survive the overdose, Murphy said the reality is that the five out of six who don’t have accesses to care will not pursue or receive treatment and may overdose again.
A key change from the 2017 bill, Lambeth said, is that some of the 90 percent federal government match would be dedicated to providing rural counties with grant funding for healthcare needs. Grants would be limited to $1 million per year.
Among the option for the funds are physician recruitment; expanding telehealth services; expanding Broadband services; loan forgiveness programs; start-up funding for new clinical patient services; physician retention incentives; and infant mortality reduction initiatives.
The goal is having the legislation in effect by July 2020. Lambeth said it would take at least a year for federal Centers for Medicare and Medicaid Services to approve a required waiver if the bill were to become law.
CMS made clear Oct. 25 it would not consider Medicaid expansion proposals — including a requirement that some recipients must work to receive benefits — unless these are first approved by a legislature.