Deal on Medicaid expansion clears first vote in NC Senate. Here’s what’s next.

The North Carolina Senate agreed Tuesday to expand Medicaid, casting an initial vote on the bill that would extend health care to thousands of people.

House Bill 76, “Access to Health Care Options,” would expand the Medicaid program to cover all adults with income below 138% of the federal poverty level.

“We have been talking about this for a long time,” Sen. Joyce Krawiec, a Kernersville Republican, said on the Senate floor. “Actually we’ve been talking about it long before many of us even arrived here in the Senate.”

Krawiec said that while she and other Republicans opposed expansion for many years, now “the time is right for North Carolina to expand Medicaid.”

“It should give us improved access and better outcomes,” she said. “That’s certainly the plan.”

In North Carolina, childless adults are not eligible for Medicaid, while the current income limit eligibility for a parent or caretaker is at 41% of the federal poverty level. This leaves many in a health insurance coverage gap — making too much to qualify for Medicaid, but too little to receive subsidies to help them buy insurance on a federal marketplace.

Senators backed the bill Tuesday with broad, bipartisan support by a margin of 43 votes to two.

What’s next?

The bill requires one more Senate vote, which will likely occur Wednesday, before returning to the North Carolina House for an up-or-down “concurrence” vote.

The House filed and passed the initial version of the expansion bill in February before passing the debate over to the Senate.

In March, a compromise between the two chambers was announced, and an expansion bill, based on the House’s preliminary version, emerged in the Senate.

After the concurrence vote, the bill will go to Gov. Roy Cooper’s desk to become law or be vetoed.

Still, there’s more.

The expansion bill is tied to funding within the state budget, which means if the budget does not pass, neither does expansion. The expansion bill stipulates the budget must be signed into law by June 30, 2024. Tying expansion to the budget means there will be policy trade-offs.

Medicaid expansion under the compromise bill won’t take effect until the budget becomes law and the federal government approves a start date.

According to a spokesperson for the state’s Department of Health and Human Services, 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.