GREENSBORO, N.C. (WGHP) – Kody H. Kinsley, North Carolina’s secretary for Health and Human Services, sent a letter to the leaders of the General Assembly last week telling them they should expand Medicaid this month or lose more than $1 billion in federal payments and jeopardize medical coverage for thousands of residents.
At least one Republican leader in the state House thinks that a deal to pass such a bill could happen at any time, and negotiations with leaders of the state House are continuing.
Kinsley’s letter, dated Sept. 3, to Senate Leader Phil Berger (R-Eden), House Speaker Tim Moore (R-Cleveland) and “hospital executives,” outlined why September was a deadline if the state wanted to realize significant federal dollars in the next six or seven months and protect people whose coverage could expire.
“Given the significant strain on our health care system – particularly with regard to mental health – it is urgent we pass legislation to expand Medicaid and establish the Healthcare Access and Stabilization Program (HASP) so North Carolina can reap the benefits,” Kinsley wrote. “A failure to act in September will have significant health and financial consequences.”
The letter said that, once live, North Carolina could draw more than $500 million per month. And – in underlined type – he wrote, “Passing legislation in September is likely our last chance to go live this calendar year.”
Kinsley wrote that if the state passed Medicaid by the end of the year, it would receive what he called a “signing bonus” of $187.5 million per quarter over eight quarters and that the state would receive $562.5 million in three payments – if “we go live before 2023” – to be used for mental health, rural health and other initiatives.
Where expansion stands
To catch you up on where this process stands, we return to mid-July, a couple of weeks after the end of the General Assembly’s short session, when Gov. Roy Cooper and state Rep. Donny Lambeth (R-Winston-Salem), a principal in Medicaid expansion legislation, were expressing hope and optimism that even though the session had been completed that Medicaid could be expanded soon.
The issue was that Republican leaders in the Senate and the House couldn’t get on the same page with the same bullet points under the umbrella of removing North Carolina from a list of 12 states that had not expanded Medicaid since the passage of the Affordable Care Act.
Berger, a converted longtime opponent, had led the bipartisan passage of an expansion bill in the Senate. That bill also took steps to broaden access to health care to counties where that is a problem. These included easing the way that new medical facilities can be licensed to open, expanding telehealth and allowing nurse practitioners to take on more tasks reserved for physicians.
The House, though, declined to take up the Senate’s bill and proposed its own bill, which called for another study team to work through the plans and report back in December for a potential vote. Lambeth, cochair of the House Health Committee, had participated in a study and in 2021 wrote the Medicaid bill that the House passed and the Senate then adjusted and passed. He also was part of creating this most recent bill in the House that the Senate hasn’t considered.
The wedge is that some hospital systems opposed part of the Senate’s bill because it included new requirements for a “certificate of need,” which is the process for approving new medical facilities to open. That opposition could affect political stability, too, because the House’s bill had suggested taking up the matter after the election on Nov. 8.
Optimism about a deal
Rep. Jon Hardister (R-Whitsett), the House majority whip, said Tuesday he hasn’t been part of recent discussions but expressed optimism – as he had previously – that a deal could be made.
“It is my understanding that Secretary Kinsley and Speaker Moore have been communicating,” Hardister wrote in a text message to WGHP. “I don’t know what the timeline is, but I think it is possible that a deal could be reached at any moment.”
A spokesperson for Berger said it was the Senate leader’s understanding that discussions were continuing.
“The Senate has already passed Medicaid expansion and HASP,” Lauren Horsch, Berger’s deputy chief of staff for communications, wrote in an email to WGHP. “While Sen. Berger is not actively involved in negotiations, it is our understanding that conversations about Medicaid expansion packaged with other health care reforms that lower the actual cost of care continue to take place.”
Emails to Lambeth and state Sen. Joyce Krawiec (R-Kernersville), who had led with Berger the passage of the bill in the Senate, seeking comment about the letter, did not draw immediate responses.
Why now?
Kinsley’s letter said the urgency to pass the legislation was based on a 3-month window that would be required after expansion and HASP were adopted. He said that timetable was based on how HASP payments are made and the time required to implement the system.
He wrote that if expansion were not passed until December – as the House’s legislation had suggested – the state could not “go live” until at least April 2023 and that “thousands of North Carolinians would lose their health coverage because their temporary Medicaid eligibility would expire at the end of the federal public health emergency before they can get covered under Expansion.”
He also wrote that this would cost rural hospitals and other what he called “safety net providers” significant revenue.
“We are ready to move forward with this opportunity to save lives, save rural hospitals, support mental health, and bring at least $8 billion per year to North Carolina,” his letter said in closing.
