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RALEIGH, N.C. (WGHP) – On Monday night, in one of the major points of his State of the State address to the North Carolina General Assembly, Gov. Roy Cooper celebrated the recent announcement that the Senate and House had reached an agreement to expand Medicaid in North Carolina – which was met in the room with mixed applause – and implored lawmakers to go ahead and do the deal now and wait no longer.

Some in the Senate must have taken heed, because on Tuesday and Wednesday the negotiated amendments of House Bill 76 sailed through reviews in the Senate Health and Finance committees. Then on Thursday morning it cleared through the Rules Committee, as well.

Senate Leader Berger (left) and House Speaker Tim Moore announce a deal on Medicaid expansion. Rep. Donny Lambeth is behind them.

HB 76, called “Access to Healthcare Options,” could be voted on by the full Senate on Monday night, its author, Rep. Donny Lambeth (R-Winston-Salem) said in an email, and then it could clear its conference vote in the House on Wednesday. If all that works, it would find its way to Cooper’s desk for an official signature.

Cooper long has been an advocate for the state to cease its rejection of the billions of dollars from the federal government allotted in 2010 under the Affordable Care Act and offer expanded medical coverage to 600,000 or so residents who could be without it.

It’s that financial windfall that Cooper used in his remarks as a carrot for leadership who had said that expanded benefits would happen as part of the passage of the state’s biennial budget, which can be a lengthy process that further delays coverage and the $500 million incremental payments the state would receive.

North Carolina Gov. Roy Cooper waves as he leaves the House chamber after delivering his State of the State address to a joint session of the N.C. General Assembly on Monday. (Travis Long/The News & Observer via AP)

“Do it now,” Cooper implored the assembled lawmakers. “Don’t wait. No business would make such a decision.”

In their announcement of the agreement, Sen. Leader Phil Berger (R-Eden) and House Speaker Tim Moore (R-Cleveland) had predicted Cooper’s response but were adamant that expansion be tied to the budget’s passage, calling it a “budgetary matter.”

The amended bill does allow local hospitals to seek reimbursement through the federal Healthcare Access and Stabilization Program (or HASP) as soon as the bill becomes law, which provides facilities that are struggling in rural areas to have a new influx of dollars without delay.

HB 76 was orchestrated by Lambeth, a retired hospital administrator, who called it a stripped-down version of the broader expansion the Senate passed last summer with Senate Bill 408which included various concepts to senators believed would provide greater access to healthcare in rural counties. That bill passed the Senate with near-unanimous support but never gained traction in the House.

Lambeth, who attended both committee meetings, was part of the group that negotiated the bill that is advancing through the Senate, and he might be kind of a proud father.

“It is a good compromise and certainly moves NC forward to vastly improve healthcare in NC,” Lambeth told WGHP last week.

State Sen. Ralph Hise (R-Spruce Pine), another longtime advocate of expanding Medicaid, introduced the amendments to both committees. In Health on Tuesday he outlined the details that Berger had revealed during the press conference on Thursday, when the compromise was announced:

  • The elimination of a certificate of need for:
    • Behavioral health beds.
    • Chemical dependence beds.
    • Raise replacement equipment threshold to $3 million and index to inflation.
    • Increase threshold for diagnostic centers to $3 million and index to inflation.
    • MRI machines in counties with a population above 125,000 effective three years from first HASP payment.
    • Ambulatory surgery centers in counties with a population above 125,000, effective two years from first HASP payment for multispecialty and single specialty.
      • 4% charity care requirement for ambulatory surgery centers (in counties with population above 125,000).
      • Annual reporting requirement regarding charity care.
  • HASP would become effective immediately.
  • Medicaid expansion would be effective only upon passage of the 2023 budget.

The Finance Committee hearing on Wednesday addressed only the financial aspects of the bill, and Hise cited three: the removal of some individuals from state exchange roles because they would be eligible for Medicaid, which changes tax collection; the reduction in fees where no longer required for certificates of needs; and the restructuring of HASP that would return to hospitals $2 for every dollar they pay in fees.

The parameters for a certificate of need were one of the big issues in disagreements between the chambers, and hospital associations had lobbied heavily to have it adjusted.

State Sen. Joyce Krawiec (R-Kernersville) pushed the bill through the Senate last year, and she had emphasized the changes to CON as part of expanding access to health facilities in rural counties.

Moore said last week that legislators “consulted with stakeholders … hospitals … healthcare providers … you name it … to get varying points of view. We came up with something that I believe is very carefully crafted and an appropriate balance for where we are in North Carolina.”

North Carolina Medical Society CEO Chip Baggett said last week that this compromise bill “represents a true commitment to the people of North Carolina and their health. It is legislation the NCMS has long considered of utmost importance, and we thank everyone who has helped move it forward.”

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Krawiec, who with Berger had pushed the expansion last summer in a dramatic reversal from their earlier opposition, said in an email that she is “delighted that Medicaid expansion will become a reality in North Carolina. Many of our hard-working families will now be able to receive the health care they need, without any cost to the state.”

Berger and Moore announced on Wednesday afternoon that they had agreed on the first aspects of their 2-year budget: a 6.5% increase for 2023 and 3.75% for 2024.

“Reaching this agreement with the Senate on the overall spend is an encouraging start to crafting another responsible budget that addresses the needs of North Carolinians, including key investments in teacher and state employee raises, infrastructure, and workforce development,” said Moore, who has promised to deliver his spending plan to the Senate by Easter, which is April 9.