RALEIGH, N.C. (WGHP) – With most of the talk around the North Carolina General Assembly focused on the soon-to-be-released state budget, the House is suggesting there be more talk about Medicaid expansion.

Republican leadership in the House Rules Committee today introduced a committee substitute to Senate Bill 408, which is the bill the House gutted last week and replaced with its own plan to expand Medicaid and offer aid for rural health care.

State Rep Donny Lambeth (R-Winston-Salem)

If you recall the Senate had earlier this month passed a bill, sponsored by Senate Leader Sen. Phil Berger (R-Eden) with Republican colleagues Joyce Krawiec (R-Kernersville) and Jim Perry (R-Lenoir), that adapted and approved House Bill 149, which had been drafted by state Rep. Donny Lambeth (R-Winston-Salem) following the research efforts by a joint legislative committee. That bill was approved last year by the House.

Lambeth said in an email to WGHP that he had been part of this new process and that he is optimistic about it getting through the House. He also described how this approach differs by including the Department of Health & Human Services.

“I do believe it will work its way through the committee process and be on the House floor and will be approved,” he said. “It is a little different. But should accomplish the same goal. 

“Basically it directs the secretary of HHS to work with federal folks at CMS and work out as many details as possible. Bring back a specific NC plan and the committee set up will make a recommendation to the chambers in December for a vote up or down.”

Berger and House Speaker Tim Moore (R-Cleveland) had warmed to Medicaid expansion, long touted by Gov. Roy Cooper, but Moore said Republicans in the House were not inclined to vote on the Senate’s bill in this short session. Then a new bill, the gutted Senate Bill 408, was introduced last week and left in committee.

Now comes this PCS to that bill, which creates a new process to draft an expansion that would be considered in December. It’s unclear when that work might find its way to a full review by both chambers, given that there are no sessions scheduled between the election on Nov. 6 and the convening of the 2023 “long session” with new membership.

Requests for comment from Berger and others are involved. Democrats were getting their first view of the proposal and a briefing.

What’s in the plan

The substitute for SB 408 would create a Joint Legislative Committee on Medicaid Rate Modernization and Savings that would hear a Medicaid Modernization Plan to be developed by the HHS by Dec. 15 and for the General Assembly to act on it by Dec. 16. That plan would:

  • Add Medicaid coverage for adults aged 18-64 with incomes up to 133% of the federal poverty level beginning on a date to be proposed by the Secretary of DHHS.
  • Increase hospital assessments to provide funding for the nonfederal share of the cost of the additional Medicaid coverage.
  • Propose legislation to enact increased hospital assessments to pay the nonfederal share of an increase to Medicaid hospital reimbursements through the Hospital Access and Stabilization Program.
  • An investment of $1 billion to address the opioid, substance abuse and mental health crisis using savings from the additional federal Medicaid match available under the American Rescue Plan Act).
  • Include specific proposals to increase access to health care in rural areas.

That last item – expanding health care in rural areas – is vague on points that Senate leaders had touted as important to help expand access to health care. They have included an easier process to obtain certificates of need on new medical facilities, expansion of telehealth access and broadening of the medical practice of nurse practitioners that could alleviate the workload on doctors.

Krawiec at the time of introducing the Senate’s version touted all those steps as important for rural hospitals. “Those are three things our hospitals have been telling us they most wanted,” she said. “This bill pairs with other actions to improve care.”

‘A win-win option’

The substitution plan calls for the joint committee to consist of six House members and six Senate members, although who they might be this time around is unknown. They would be appointed by Berger and Moore, who presumably would be among them.

The plan also places a requirement for participation by DHHS to help form the details of what it calls the Medical Modernization Plan. This includes details in the requirements of the plan and in setting up a plan to hold funds from the American Rescue Plan and to seek execution of the Medicaid reimbursement for hospitals.

There’s also a component for a workforce development plan to be developed by the Department of Commerce.

“I believe we are making good progress and will end up at a good place before the end of the year and then begin to roll out a NC Medicaid plan that is fiscally sound and a win-win option for all persons in need of improving health care access,” Lambeth said. “NC ranks 43rd in access to care and we can move up to one of the top states in the nation.”