This article was first published by NC Policy Watch. Story by Lynn Bonner.

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North Carolina is on track to allow about 600,000 people to gain health insurance through Medicaid expansion. 

House and Senate leaders announced at a news conference Thursday morning that they had reached a deal on expansion.

House Speaker Tim Moore called the agreement “carefully crafted and appropriately balanced.”

Republicans opposed Medicaid expansion for years, while Democrats supported it. Prospects for expansion changed last year when Senate leader Phil Berger announced he had changed his mind. 

A sticking point between the House and Senate had been health policy changes that Senate Republicans wanted attached, which included changes to the state certificate of need law. 

Under the law, healthcare providers need state permission to expand, buy major pieces of equipment, or offer new services. Hospitals had vigorously fought any changes to the law. 

The Medicaid expansion agreement includes certificate of need changes that Berger called “the most significant modification” since the law was enacted. 

The changes:

  • Eliminate certificate of need for behavioral health beds, for chemical dependency beds.
  • Raise the replacement equipment threshold to $3 million and index that number to inflation.
  • Increase the threshold for diagnostic centers to $3 million and index that to inflation.
  • Eliminate a certificate of need for MRIs in counties with a population of 125,000 or more.
  • Eliminate a certificate of need for ambulatory surgical centers in counties with a population above 125,000.

Surgical centers that are exempt from certificate of need under the provision will be required to have a 4 percent charity care requirement for those centers in the counties with populations above 125,000.

There will be an annual charity care reporting requirement.

HASP (Healthcare Access and Stabilization Program) will become effective immediately upon enactment of the legislation.

“What I was thinking about the whole time when Senator Berger was going through is what a huge announcement this is for North Carolina – what a huge policy direction this is,” Moore said. “That’s going to provide help for so many in this state. But it’s going to do it in a way that is fiscally responsible.”

Under the agreement, Medicaid expansion would be effective upon passage of the budget.

The agreement was finalized last night and the finishing touches added this morning, Moore said. 

House Speaker Tim Moore and Senate President Phil Berger.

The NC Healthcare Association said in an email that it appreciated that a proposal it made on certificate of need changes last fall was part of the process in getting to the agreement.

The Healthcare Association and other groups that have been working for Medicaid expansion applauded the announcement. 

Care4Carolina, a coalition that counts 166 members, called the announced agreement “a giant step toward making affordable healthcare accessible to hundreds of thousands of North Carolinians who are currently in the healthcare coverage gap.”

Expansion would benefit low-income adults without dependent children who earn too much to qualify for regular Medicaid but make too little to qualify for subsidized insurance in the ACA marketplace. 

“The statewide Care4Carolina coalition joins thousands upon thousands of North Carolinians today in celebrating the announcement that the NC Senate and NC House have reached an agreement to expand Medicaid in our state, and thanks the members of the NC General Assembly for their hard work,” Care4Carolina executive director Abby Emanuelson said in a statement. 

“We are especially grateful to President Pro Tem Phil Berger and Speaker Tim Moore for their persistence and vision in bringing this life-saving issue to this important juncture. We look forward to working hand in hand with them to see it through,” the statement said. 

The federal government will pay 90 percent of the cost of people who gain Medicaid under expansion, and state proposals have had hospitals and insurance companies picking up the other 10 percent.

The federal government is also offering states that have not yet expanded Medicaid a financial incentive to do so. North Carolina, one of 11 states that has not acted on expansion, would be in line to get about $1.5 billion. 

Democratic Gov. Roy Cooper said in a statement that the agreement is “a monumental step that will save lives.”

He commended the “hard work that got us here,” but said changes shouldn’t wait. 

“Since we all agree this is the right thing to do, we should make it effective now to make sure we leverage the money that will save our rural hospitals and invest in mental health. I look forward to reviewing the details of the bill,” Cooper’s statement said. 

Senate Democratic leader Dan Blue of Wake County said in a statement that Medicaid expansion has been “a long time coming for working families in our state.

“Governor Cooper and Democratic lawmakers have never stopped fighting for better access to good, affordable healthcare. This is a lifeline for working adults and rural communities.”

Policy Watch senior producer Clayton Henkel contributed to this report.

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