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EXPANSION (NC)- Medicaid expansion delayed because of no final budget

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: Welp.

 
 

 
 

Clipped from: https://spectrumlocalnews.com/nc/charlotte/news/2023/08/29/medicaid-expansion-won-t-begin-in-north-carolina-on-oct–1-because-there-s-still-no-final-budget

RALEIGH, N.C. (AP) — With the state budget’s passage now two months late, North Carolina Gov. Roy Cooper’s administration announced Monday that it can’t start the implementation of Medicaid expansion to hundreds of thousands of low-income adults in the early fall as it had wanted.

What You Need To Know

  • Oct. 1 was unveiled as the start date in July, provided that a budget law was enacted by Sept. 1
  • As many as 600,000 adults who earn too much to qualify for traditional Medicaid but too little to receive even heavily subsidized private insurance would be covered under the expansion
  • NCDHHS Sec. Kody Kinsley said a new launch date won’t be determined until the General Assembly gives his agency final authority for expansion, which he said could happen as early as December or “it could slip into 2024”

State Health and Human Services Secretary Kody Kinsley said that expansion won’t begin on Oct. 1, which in July he unveiled as the start date — provided that a budget law was enacted by Sept. 1.

A separate expansion law that the Democratic governor signed into law in March required a budget law be approved before people could start receiving coverage. Kinsley’s office had been working closely with federal regulators to get expansion off the ground quickly once legislators completed that final step.

But Republican House and Senate leaders in charge of the General Assembly have been slow in negotiating this summer a budget law that was supposed to be in place by July 1. The GOP holds veto-proof majorities in both chambers, leaving Cooper, who would be asked to sign the final budget into law, in a weak position to force action.

GOP lawmakers had signaled earlier this month that a budget wouldn’t get settled until September, and had declined to decouple Medicaid expansion implementation from the spending law. Both chambers scheduled no formal voting this week.

“It’s become clear to us that we will not be able to have a budget passed in time and enacted, nor will we have separate authority to move forward,” Kinsley told reporters. Kinsley said a new launch date won’t be determined until the General Assembly gives his agency final authority for expansion. He said it could happen as early as December, or “it could slip into 2024.”

“Our team will continue to work hard to have all of the tools ready and necessary to move forward on expansion, just as soon as we have clarity from the General Assembly about our ability to do so,” Kinsley said.

State officials have estimated the expansion of the government-funded health coverage would cover as many as 600,000 adults who earn too much to qualify for traditional Medicaid but too little to receive even heavily subsidized private insurance.

Kinsley has said about 300,000 people who already participate in a limited Medicaid program for family planning benefits such as contraception, annual exams and tests for pregnancy would automatically gain the broader, expanded Medicaid coverage on the first day of implementation.

“This is a tragic loss of health insurance … delaying something that we know they and their families need so badly,” he said.”This is a tragic loss of health insurance … delaying something that we know they and their families need so badly,” he said.

Kinsley also said that several thousand people being removed monthly from traditional Medicaid rolls due to income now that eligibility reviews are required again by the federal government following the end of the COVID-19 pandemic would be quickly returned to coverage under the expansion.

Top legislative Republicans — Senate leader Phil Berger and House Speaker Tim Moore — have said they remain committed to getting expansion up and going. They have said that budget votes could come in mid-September.

“Our priority is to put together the very best budget for all North Carolinians,” Moore said later Monday in a statement, adding that work on it would continue this week.

Cooper has criticized Republican legislators for the delay, which in turn has prevented the state from getting sooner over $500 million per month in additional federal funding that expansion would bring.

“North Carolinians have been waiting for Medicaid expansion for a decade. Because of Republicans’ ongoing budget delay, that wait continues with no end in sight,” Senate Minority Leader Dan Blue and House Minority Leader Robert Reives said in a news release.

North Carolina had been among 11 states that haven’t accepted expansion from the federal government before Cooper signed the expansion bill on March 27.

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EXANSION (NC)- NC Senate budget: Where does Medicaid expansion stand

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: Ruh-roh. When I said I was ok with removing CON, I did NOT mean the ones that protect my fiefdom. (Read this line in the voice of the NC Hospital Association).

 
 

 
 

Clipped from: https://www.newsobserver.com/news/politics-government/article275435491.html

Politics & Government


By Luciana Perez Uribe Guinassi

Updated May 16, 2023 7:21 PM

The Senate budget unveiled Monday cuts state laws that regulate hospital competition, placing Medicaid expansion, and health coverage for thousands of low-income North Carolinians, in conflict.

During last year’s Medicaid expansion negotiations, a key disagreement between the House and the Senate was Certificate of Need laws, which limit where hospitals, clinics and other health care facilities can be built. The Senate wanted to pass expansion with Certificate of Need changes but the House did not.

But this year, there was a breakthrough, and in early March, the Senate and House announced that they had reached a compromise deal: Medicaid expansion would pass and it would cut some CON regulations for health care facilities.
The compromise bill would also include a new reimbursement program for hospitals.

By the end of March, Gov. Roy Cooper signed expansion into law at a ceremony at the Executive Mansion in downtown Raleigh, opening the door for health insurance coverage to 600,000 low-income North Carolinians, who would be newly eligible for the program under its enhanced eligibility parameters.

There was a big caveat, though. Expansion would be contingent on the passage of the state budget, setting up the stage for roadblocks during potentially contentious budget negotiations.

The Medicaid expansion law signed by Cooper eliminates CON requirements for behavioral health beds and chemical dependency beds, among other cuts.

Meanwhile, the Senate’s budget bill takes “a sledgehammer to those archaic and unnecessary Certificate of Need laws that remain on the books,” said Sen. Ralph Hise, Monday, during a press conference to unveil the budget.

“These common sense changes will build on the CON reforms we included in the Medicaid expansion package and drive down costs and increase availability for patients,” he said.

What happens next?

Senate leader Phil Berger addressed Monday how the proposed CON changes could affect the House compromise and Medicaid expansion.

“I suspect there’ll be a number of things in this version of the budget that will create conflict with what the House did and we’ll work that out,” Berger said at during a budget press conference Monday.

The House passed its version of the budget in April. Berger said the Senate expects to pass its version this week, followed by negotiations between both chambers.

“That’ll set up conference, because I’m pretty sure that the House will not concur in the changes that we make,” Berger said. “So even if it takes us three weeks in conference, that’s still the middle of June getting it done. So I think, we’re on track to get the budget done before the end of the fiscal year.”

Pressed further on how expansion fell through because of CON change disagreements, Berger said, “I don’t anticipate us reaching a stalemate with the House. We will see what happens but I don’t anticipate that.”

Details on changes

The compromise expansion bill signed into law eliminated certificate of need requirements for behavioral health beds and chemical dependency beds. For counties with a population of 125,000 or more, it eliminates CON requirements for MRI machines and ambulatory surgical centers. These provisions would become effective years down the line, as previously reported by The News & Observer.

Under the new Senate budget, CON laws would be repealed:

  • for ambulatory surgical centers and facilities with Magnetic Resonance Imaging (MRI) machines, in counties with a population under 125,000 that do not have a hospital.

     
  • for mobile MRI machines, linear accelerators, physician office-based vascular access for hemodialysis, and kidney disease treatment centers.

     
  • for the conversion of special ambulatory surgical programs to multispecialty programs and for the addition of a specialty.

The North Carolina Healthcare Association, a powerful interest group that represents hospitals, had been against cutting CON laws — and tying CON reform to Medicaid expansion — saying that it would erode access to care.

By limiting how many providers can offer lucrative services, CON helps hospitals ensure they can offset operations losses for things such as Medicaid care, said the NCHA, as previously reported by The N&O .

Cynthia Charles, a spokesperson for the NCHA, said Monday that the association was reviewing the budget proposal and didn’t yet have a comment about the changes.

How Medicaid funds are spent in the budget

Beyond CON provisions, the Senate budget lays out how Senate Republicans would like to spend the Medicaid funds — including a one-time, $1.6 billion bonus from the federal government granted under the American Rescue Plan Act.

Hise said the Senate prioritizes spending the money to address behavioral health needs and health care workforce shortages.

The state Department of Health and Human Services has seen a vacancy rate of 25.9%, as previously reported by The N&O.

According to a press release by Republicans, of the sign-on bonus:

The budget also allocates $6 million of the money to the nonprofit Carolina Pregnancy Care Fellowship for crisis pregnancy centers.

This story was originally published May 15, 2023, 7:04 PM.