After years of waiting, North Carolina’s hospitals celebrate Medicaid expansion deal
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Medicaid expansion in North Carolina
The House and Senate have agreed to pass Medicaid expansion, reaching a breakthrough after years of debate. North Carolina is one of just 11 states that has not adopted Medicaid expansion under the federal Affordable Care Act.
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After years of waiting, North Carolina’s hospitals and health care providers received long awaited news Thursday when the state House and Senate reached a deal on Medicaid expansion.
North Carolina is one of 11 states that have still not expanded Medicaid, something the state’s hospitals and their lobbying groups have pushed against for years.
If adopted, the income limit would be pushed up from 41% of the federal poverty level to 138%. That could make an estimated 600,000 low-income North Carolinians eligible for the program.
READ MORE: Q&A: What you need to know about the Medicaid expansion deal between NC House and Senate
This could be “transformative” for access to health care in rural areas, for better mental health care for veterans, and for working adults and their families, the NC Department of Health and Human wrote in a press release.
Currently, hundreds of thousands of North Carolinians fall into a “medicaid coverage gap,” which means they make too much to qualify for Medicaid, but too little to qualify for subsidized marketplace plans. A disproportionate percentage of adults in this group are people of color, according to a Kaiser Family Foundation report.
That leaves many of the state’s poorest residents uninsured, which can worsen health outcomes. A 2021 study found that Medicaid expansion was associated with a nearly 4% reduction in adult deaths per year.
“Everybody, if they get sick enough, will have access to health care,” said UNC chief clinical officer Dr. Matt Ewend. “But that’s an awful way to try to treat folks and it’s health care instead of health.”
Thursday’s announcement could finally close that gap, though it’s not certain that Medicaid expansion — which lawmakers want to tie to the state budget — will make it through.
“While we know this is just one step in the process toward passage, it’s a step that is vital and moves us closer to the expanded, equitable and accessible care all North Carolinians need,” a spokesperson from Novant Health in Charlotte said in a statement.
READ MORE: Many opponents of Medicaid expansion in NC have changed their minds, but not all
Donald Gintzig, president and CEO of WakeMed, said that if the insurance program is expanded, it would broaden access not only to illness treatments, but also to preventative care to prevent the onset of illness in the first place.
Improving access to cancer screening and primary care appointments, among other things, could help the health of North Carolinians as a whole.
Dr. Tom Owens, senior vice president for Duke University Health System, agreed.
“We see patients every day who delay care because they don’t have adequate or don’t have any health insurance,” he said. “They end up with severe consequences from that disease that could have been treated earlier.”
Atrium Health in Charlotte declined comment.
Chip Baggett, executive vice president of the NC medical society, said doctor practices have to consider whether and how their patient population is insured to make sure they’re making ends meet.
Medicaid expansion could allow these practices to take on more low-income patients by assuring the practice that it’ll be reimbursed for the care provided.
“Doctor practices are businesses just like everything else. They have bills and staff and supplies and mortgages they have to pay,” he said. “They do take into account the mix of payers.”
The House and Senate lawmakers said they would also bump up Medicaid reimbursement rates, which hospitals say are much lower than the cost of providing care, using a federal reimbursement program known as HASP.
Participating in the reimbursement program unlocks $8 billion of federal funds at no additional cost to the state. Owens said it is “perplexing” that the state has not yet taken advantage of this program.
“We’re competing for talent with other states that have access to this funding from the federal government,” he said. “They’re able to pay higher salaries and recruit in ways that we have struggled to.”
Ultimately, the hospital executives said, while they had hoped Medicaid expansion could have happened years ago, it’s better late than never.
“I certainly wish this has happened sooner,” Owens said. “But I’m so glad it’s happening now.”
Teddy Rosenbluth covers science and health care for The News & Observer in a position funded by Duke Health and the Burroughs Wellcome Fund. The N&O maintains full editorial control of the work.
This story was originally published March 3, 2023 at 12:36 PM with the headline "After years of waiting, North Carolina’s hospitals celebrate Medicaid expansion deal."
