Medicaid expansion could face familiar challenges in a divided NC House and Senate

Medicaid expansion could face familiar challenges in a divided NC House and Senate

Medicaid expansion in North Carolina is still in a bind this term, with a sticking point between the House and Senate likely to return.

Legislators in the state Senate on Tuesday filed a bill that would repeal North Carolina’s Requirement Certificate Ordinance, a law that requires healthcare providers to obtain state approval for new healthcare facilities, the purchase of medical equipment and more.

During the last legislature, Medicaid expansion seemed on the verge of a breakthrough, but disagreements between the House and Senate over what the law should look like stalled negotiations.

In June, the Senate passed, by a near unanimous vote, a bill expanding Medicaid with changes to the CON regulation. The House of Representatives passed a separate bill authorizing a study that would require a second vote to authorize the expansion, previously reported by The News & Observer.

In March, the House and Senate both filed CON repeal bills that appeared to be identical. None passed.

“We’re willing to look at CON reform,” House Speaker Tim Moore, a Cleveland County Republican, said Wednesday, “not CON repeal … I don’t expect we’ll take up their standalone bill.” will.”

Moore said talks about CON would likely be part of a much larger conversation when lawmakers put together the next state budget. When asked if CON would be associated with the Medicaid expansion debate this year, Moore said he doesn’t know “whether those talks will happen at the same time or not,” and that the last session of the House of Representatives took the position that introducing cost controls was a good problem to deal with on your own.

“But historically, you tend to lump these kinds of problems together,” Moore said. “So we’ll see… There was no preliminary decision.”

Senate Chairman Phil Berger, a Rockingham County Republican, could not be reached for comment, nor could most of the bill’s supporters. Jim Burgin, a Harnett County Republican and another supporter of the bill, was unable to speak Wednesday, according to a spokesman.

External resistance to the repeal of the CON

One of the strongest opponents of CON repeal in the 2021-22 legislative session was the North Carolina Healthcare Association, an advocacy group representing hospitals.

Asked Wednesday about the group’s position on the Senate’s new CON bill and its position on the Medicaid expansion, Cynthia Charles, spokeswoman for the Healthcare Association, said in a statement that the organization made a proposal in its most recent meeting in response to Medicaid -Expansion bill passed the Senate.

The letter was sent to Democratic Gov. Gov.’s Roy Cooper, Berger and Moore in September and proposed concessions for Certificates of Need for outpatient surgical centers and inpatient beds for patients with psychiatric problems and chemical addiction, as previously reported by The N&O.

In the letter, NC Healthcare Association executive chair Roxie Wells said that “NCHA and our members have urged elected leaders to expand Medicaid to improve the health of our neighbors and communities for over a decade.”

“In an effort to move stalled negotiations, and in response to Senator Berger and Gov. Cooper’s call for Medicaid expansion to be coupled with requirement certificate reform, our board of trustees made the difficult decision to approve reforms to the requirement certificate law propose,” Wells said. “Changes to the CON Act could threaten the survival of community hospitals if not carefully implemented.”

Charles said the association was still analyzing the latest CON bill and hadn’t had a chance to discuss it with members or the bill’s sponsors.

“In general, we believe that any changes to the Attestation of Requirements Act should take into account the current and near future operating environment for hospitals and healthcare systems,” she wrote to The N&O.

Throughout 2022, hospitals “faced significant inflationary pressures and skyrocketing labor costs,” Charles said, and many continue to report negative financial operating margins.

“North Carolina has serious issues that we are trying to solve to ensure the people of our state have equal access to quality health care and are as healthy and productive as possible,” she added. “Leaders in the Legislature should be careful not to implement policies that could unintentionally impair access to health services in local communities, particularly safety-net services that North Carolina residents rely on. We look forward to continuing the dialogue with them on these issues.”

North Carolina would be one of the last states to introduce the Medicaid expansion under the Affordable Care Act. Medicaid provides health coverage through state and federal funds to certain low-income and needy individuals.

In North Carolina, childless adults are not eligible for Medicaid, while the current income limit for a parent or guardian is 41% of the federal poverty line. With the expansion, the eligibility would increase all adults with incomes up to 138% of the federal poverty line.

According to an estimate by the State Department of Health and Human Services, this would mean an expansion Target 600,000 low-income North Carolinians for the program and increase access to health care statewide, especially in rural communities.

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