North Carolina: Expansion of Medicaid Should Serve as an Inspiration to Other States

- Center for American Progress, March 27, 2023. - Ed.

North Carolina has approved Medicaid expansion—a move to bring in federal funds to bolster rural hospitals and increase resources for mental health.

In the 13 years since the signing of the Affordable Care Act (ACA), there is mounting evidence of Medicaid expansion’s benefits for both enrollees and the sustainability of health care providers. As a result, momentum is increasing in some of the 11 remaining nonexpansion states. After years of negotiation, North Carolina passed a bipartisan bill to adopt Medicaid expansion that Gov. Roy Cooper (D) is scheduled to sign today. Assuming the state finalizes expansion in the coming months as part of the state’s biennial budget, North Carolina will be the 40th state to adopt expansion.

While the implementation of Medicaid expansion does not have a set start date as it is contingent on the passage of the state’s 2023-2024 budget, as well as approval by the Centers for Medicare and Medicaid Services, expansion is projected to result in a 30% decrease in North Carolina’s uninsured rate. An estimated 600,000 North Carolinians will have access to affordable coverage, including 178,000 uninsured adults in the Medicaid coverage gap. The latter are among the approximately 2Mill adults living in nonexpansion states who have incomes too low to qualify for financial help for ACA marketplace plans yet are not eligible for Medicaid coverage.

By expanding Medicaid, North Carolina will benefit from enhanced federal funding while also alleviating pressing health care challenges, including rural hospitals’ financial sustainability and access to mental health and opioid use disorder treatment.

North Carolina’s expansion agreement capitalizes on unprecedented federal support. Medicaid expansion has been a sticking point in the state budget since 2017. Even with the governor & advocates highlighting expansion’s health, coverage, & economic benefits, the perceived cost to the state was a primary obstacle. Opponents argued that the state portion of expanded enrollee costs would lead to increased and burdensome expenses & stalemate ensued. However, the multiyear fiscal experience of expansion states & enhanced federal financing under the American Rescue Plan Act (ARPA) blunted cost concerns & reinvigorated expansion efforts. Under the ACA, 90% of expansion enrollee costs are covered by the federal government, with, with states bearing responsibility for the remaining 10%. The ACA’s Medicaid expansion is a good deal for states—the federal contribution for Medicaid expansion populations is an average of 60% greater than for traditional Medicaid populations...https://www.americanprogress.org/article/north-carolinas-expansion-of-medicaid-should-serve-as-an-inspiration-to-other-states/