NC DHHS moving forward with Medicaid expansion while waiting on state budget deal
Medicaid expansion in North Carolina won’t happen until the state budget becomes law, but the N.C. Department of Health and Human Services is moving ahead while the wait continues. The state agency announced Wednesday that it is preparing for an Oct. 1 launch.
DHHS is a Cabinet agency of Democratic Gov. Roy Cooper. The General Assembly is controlled in both chambers by Republicans, who have supermajorities. While the state budget should be passed annually by June 30, negotiations have continued this summer as Republican leadership in the House and Senate work out a final deal.
Cooper signed a Medicaid expansion bill into law this spring, knowing that most of the bill, including expansion, would be tied to the state budget becoming law.
Compromise details
N.C. DHHS said it is moving ahead because of a compromise it has reached with the federal Centers for Medicare & Medicaid Services that lets it start working on “required public notices for beneficiaries, counties and providers while still awaiting authority from the NC General Assembly.”
Medicaid expansion would extend health care coverage to hundreds of thousands of low-income North Carolinians, and has long been a political football. In previous budget stalemates, it was the subject of a partisan split on including expansion in the budget. But it’s almost a done deal now, once lawmakers agree on a final budget that will become law. If Cooper vetoes the budget bill this year, Republicans have enough votes to overturn it.
DHHS said in order to start expansion on Oct. 1, it will still need the General Assembly to take action either by separating expansion from the budget or by enacting a budget by Sept. 1.
Notices to beneficiaries will not be sent until after Sept 1, Summer Tonizzo, a DHHS spokesperson, told The News & Observer. The compromise, she said in an email, allows DHHS to submit official documentation based on the Oct. 1 effective date, “with the understanding that the date may need to be changed.”
The earliest fallback date is Dec. 1, wrote DHHS, but it could get pushed into 2024.
This early work will allow the state to cut the implementation period from 90-120 days upon receiving legislative authority to 30 days so enrollment can begin more quickly, DHHS says.
The state’s health department previously told The N&O that once the expansion bill has passed, North Carolina will need to submit a plan to the federal government.
The federal government would then have 90 days to review and approve the plan or request additional information, which would stop the clock. Once North Carolina submits a response to any request for additional information, the 90-day clock would start again, said DHHS.
Tonizzo said Wednesday that North Carolina had not yet submitted the state plan and that posting the public notice is the first step to that submission.
“The federal government has up to 90 days to review and approve a state plan. Since NCDHHS has shared drafts of the state plan amendments (needed for federal approval to launch Medicaid expansion) with CMS and has made revisions based on CMS feedback, we have CMS commitment for an expedited approval process. “ Tonizzo said.
Budget updates
Cooper’s administration has criticized this year’s budget delay, which delays raises for state employees and teachers as well as implementation of Medicaid expansion.
Senate leader Phil Berger told reporters last week that negotiations are not yet at the point that they would run some parts of it as separate bills.
House Speaker Tim Moore told reporters last week he has “not sensed any appetite in our caucus to move the expansion separate and apart from the budget.”
“So I would anticipate any expansion that happens on Medicaid to be a part of the budget that’s enacted,” Moore said.
The General Assembly does not have any voting sessions or committee meetings this week, as several lawmakers are at conferences or on vacation. Berger and Moore said budget negotiations are continuing, and sticking points are over taxes and how much to put in reserves.
“Hopefully, we can get this done sooner rather than later,” Moore said about any impact the delay has on Medicaid expansion starting. “I’m told as long as we get this done before the end of August, that we should be fine, with no issues.”
This story was originally published July 26, 2023 at 3:38 PM.
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