Both legislative chambers on Wednesday advanced a compromise bill funding the state's Medicaid program for the rest of the year while providing additional oversight of the program.
House Bill 696 uses $319 million from North Carolina's Medicaid Contingency Reserve to fund the remainder of this year's rebase request, which is used to fund the healthcare program after it becomes clear how enrollment has changed over time and how inflation is impacting funding.
"That's been a sore spot. A lot of people called, and I hope that you appreciate the amount of new money we're putting into Medicaid this year and the work we need to do for next year to understand more about what's driving that cost increase," Rep. Donny Lambeth, R-Forsyth, said in the House.
With the new funding, the General Assembly will have provided $819 million in additional money to Medicaid this year, bringing the state's total spending on the program to about $6.7 billion.
Medicaid is a federally and state-funded program that provides health insurance to low-income people, including families and people with disabilities. In North Carolina, about 2.4 million people are on the traditional Medicaid program and another 700,000 are covered through Medicaid expansion.
The rebase only covers people who are on the traditional Medicaid program because expansion is fully funded by the federal government and an assessment levvied on the state's hospitals.
The bill also follows through on Republicans' priority to put more guardrails around the state's Medicaid program, an effort legislative leaders say could be used to address its ballooning costs.
"This was a good start in some portions of the bill that deal with getting our hands around waste, fraud and abuse, and just prices that are getting out of control, whether or not it's waste, fraud or abuse," Speaker of the House Destin Hall, R-Caldwell, told reporters.
Those provisions include requiring the N.C. Department of Health and Human Services to review changes in circumstances that could impact eligibility monthly instead of quarterly; requiring applicants for Medicaid to provide evidence of eligibility beyond self attestation; and providing $500,000 to fund performance audits of the Medicaid program and the NCWorks Career Centers.
"We appreciate the North Carolina General Assembly’s commitment to fully funding NC Medicaid for the current year. We will continue working with lawmakers to ensure efforts protect and strengthen access to care for all North Carolinians," Summer Tonizzo, a N.C. Department of Health and Human Services spokeswoman, wrote in a statement.
The compromise bill also requires DHHS to implement federally required work requirements for people covered by Medicaid that were part of last year's federal H.R. 1. Under the new requirements, Medicaid applicants must spend at least 80 hours a month working, volunteering or participating in community service or at least 40 hours a month in an education program.
The Congressional Budget Office has estimated that the new work requirements will result in 4.8 million people nationwide losing Medicaid coverage over the next decade.
"This is a social safety net program where our real metric for Medicaid success is the folks who are on it, how many of them are we getting off of it because they're going back into the labor force and they're able to purchase their own insurance," Hall said.
Legislative Democrats expressed concern about some parts of the bill. But ultimately, they said, they will vote for the bill because it provides the funding the Medicaid program needs to stay solvent.
"I'm happy that we have funding, but there are some very concerning provisions within the bill that I, our caucus, do not like, appreciate and would have appreciated it being in a standalone bill because it forces us, frankly, to have to vote on a bill that we support with other terrible provisions that we do not," Senate Minority Leader Sydney Batch, D-Wake, told reporters.
Batch pointed to the monthly reporting provision as one that her caucus took issue with, particularly because it does not come with extra funding for DHHS.
The bill also requires DHHS to refer anyone who applies for Medicaid and cannot prove their citizenship to the U.S. Department of Homeland Security for investigation.
"Taxpayers don't feel like their taxes ought to be going for benefits for folks who are in this country illegally," Sen. Phil Berger, R-Rockingham, told reporters.
Immigrant rights advocacy group Siembra NC released a statement Wednesday arguing that the provision could keep families where children are citizens but their parents are undocumented from seeking healthcare or impact families where people are in the process of seeking legal status
"This isn’t about eligibility; it’s about terrorizing parents who just want to take their kids to a doctor. By forcing our county workers to act as federal informants, the state is making every child in our community less safe. North Carolina Republican Party leadership should present a clean Medicaid funding bill that provides care, not fear, to all North Carolinians," Kelly Morales, Siembra's executive director, said in a statement.
Wednesday's House vote was 112-1, and the Senate vote was 48-1. Both chambers need to take one more vote on the bill before sending the bill to Gov. Josh Stein. Those votes are scheduled to take place Tuesday.
The legislation also accomplishes a number of other goals unrelated to Medicaid, including allocating $13.1 million in recurring and $8.5 million in nonrecurring funds to the N.C. Department of Motor Vehicles; shifting $80 million to the N.C. Department of Adult Correction to address an operating shortfall; and moving $2.5 million in recurring and $1.2 million in nonrecurring funds to the N.C. State Bureau of Investigation to address a shortfall there.
