North Carolina is currently one of only 11 states that have not expanded Medicaid under the Affordable Care Act, commonly known as Obamacare. Republicans had long resisted the move over cost, but Governor Roy Cooper has pushed for the expansion since he took office in 2017, even refusing to sign state budgets that didn't include the expansion.
On Thursday (March 2nd) House Speaker Tim Moore and Senate leader Phil Berger held a news conference to announce that Medicaid expansion will be approved thanks to a compromise involving the state's certificate of need laws.
The change, when finalized, will extend the opportunity to enroll in Medicaid to some 600,000 working North Carolina adults, who have not previously been eligible because they earn more than the Medicaid income threshold, even though many of them can't afford health care, don't have employer-sponsored insurance, and find the cost of private insurance--even under Obamacare--unaffordable.
Speaker Tim Moore, who represents Cleveland County in the NC House, described the deal as “a huge announcement for North Carolina.”
According to the Kaiser Family Foundation, there are currently 1,059,800 North Carolinians without medical insurance. According to the General Assembly estimates, about 60% of those will become eligible for Medicaid.
Currently, some of the uninsured get medical treatment for them and their families from Kintegra Health, the largest FQHC (federally qualified health centers) in North Carolina. Kintegra operates in multiple Piedmont counties including Lincoln, Gaston, Catawba and Cleveland. Services and programs vary by county.
In Lincoln County, Kintegra operates what was once called the Helping Hands center, providing medical care and pharmacy services for Kintegra patients, among other services. The Lincolnton location of Kintegra Family Medicine is on Gamble Drive near the Lincoln County Health Department.
During 2021, Kintegra served over 86 thousand people in Alexander, Catawba, Cleveland, Davidson, Davie, Forsyth, Gaston, Iredell and Lincoln counties and recently expanded into Randolph County. Of those 86 thousand, nearly 32 thousand were uninsured. Kintegra offers services without regard to the ability to pay, so anyone is welcome at their facilities, but because they offer reduced pricing based on income levels, they have become the primary source of medical attention for many of those who are in the 'medicaid gap,' whose income is greater than the current Medicaid maximum but still not enough to pay for other insurance.
Kintegra also serves the undocumented population, who would otherwise most likely seek medical help at hospital emergency departments.
The expansion will be funded 90% by the federal government, with the other 10% coming from assessments on hospitals. Hospitals will receive higher reimbursements to treat Medicaid patients that could total as much as $3 billion annually. North Carolina could receive $1.5 billion over two years as part of the federal incentive, once approved.
The deal that made the expansion possible includes a partial repeal of the state’s certificate of needs laws, which mandate government approval for various health care services and equipment. That may help to extend healthcare to rural areas where people have to travel a great distance to see a doctor. The expansion will not, however, include something former Lincoln County state senator David Curtis had fought for--allowing trained nurses to take on more duties without a doctor’s direct supervision.
Both of those provisions were included in legislation to expand Medicaid that cleared the Senate last session, but wasn't passed in the House.
Legislative leaders say they expect to enact the expansion legislation this summer, and to start enrolling people next January.