On June 2nd, 2022, the North Carolina Senate voted 44-2 to pass House Bill 149 Expanding Access to Healthcare. While H.B. 149 has gotten significant media coverage related to the Medicaid expansion component, the bill includes several significant changes that will impact state health
policy and the business of health in North Carolina. H.B. 149 is composed of five sections: Medicaid expansion, work requirements for certain beneficiaries, certificate of need reform, modernization of nursing regulations, and health insurance reforms.

This CBOH Insight will break down each section of H.B.149. While Medicaid expansion is vitally important for the state and has received the most attention, we will highlight important takeaways and provide context for why specific sections of the bill remain contentious for both consumers and providers of healthcare services.

Keywords: Medicaid, NC Health Works,Telehealth

North Carolina Medicaid Expansion: A February 2023 Update

What’s New?

Medicaid expansion is back in the North Carolina policy spotlight. On February 15^th, 2023, North Carolina’s House of Representatives quickly and overwhelmingly passed House Bill (H.B.) 76, “Access to Healthcare Options.” When we last examined a North Carolina Medicaid expansion bill, H.B. 149, it was approved by the NC Senate but never acted upon by the House due to disagreements on various provisions within the bill unrelated to Medicaid expansion. The new H.B. 76 is leaner, without the certificate of need (CON), work requirement provision, and adjustments to advanced practice provider scope of practice that were present in H.B. 149. While H.B. 76 received minimal debate in the House and passed 92-22, it likely faces tougher negotiations as it moves to the Senate.

What’s Next?

With approval from the House, H.B. 76 now moves to the Senate for debate. Discussion around Medicaid expansion has been ongoing for more than a decade in North Carolina, and last year saw a turning point with the Senate passing H.B. 149. North Carolina remains one of eleven states that has not passed any Medicaid expansion provisions. If H.B. 76 can proceed through the Senate as is and is signed into law, Medicaid expansion would occur by January 2024. H.B. 76 is timely as well; by April 1^st, 2023 the Families First Coronavirus Response Act (FFCRA) will end, resulting in Medicaid eligibility reviews which North Carolina DHHS estimates could result in 300,000 North Carolinians losing their coverage.

There is currently no set date on when the Senate will convene to discuss Medicaid expansion.

North Carolina Medicaid Expansion: An April 2023 Update 

On March 27^th, 2023, Governor Roy Cooper signed into law H.B. 76, Access to Healthcare Options. This legislation will result in Medicaid expansion, making North Carolina the 40^th state to expand Medicaid. Officially, Medicaid expansion will take effect once the FY 2023-2025 appropriations act is passed and signed into law. 

H.B. 76 most notably includes Medicaid expansion, but also includes Certificate of Need (CON) reform. In our original publication discussing last year’s H.B. 149 (a previous version of a Medicaid expansion bill), we highlighted the various implications CON reform might have across the state. CON reform in H.B. 76 removes requirements specifically for chemical dependency beds, psychiatric beds, and changes thresholds for diagnostic centers, MRI machines, and Ambulatory Surgery Centers (ASCs). This version of H.B.76 also excludes the SAVE ACT, which would have expanded autonomy for nurse practitioners across the state. The SAVE ACT was originally incorporated into multiple versions of Medicaid expansion bills (such as H.B. 149) but was ultimately removed prior to signing. 

In addition to 600,000 residents now eligible to receive health coverage, billions in federal funding will flow into the North Carolina economy. Hospitals, especially rural systems, will benefit from the additional revenue Medicaid reimbursement can now bring. As North Carolina starts to see the effects of H.B. 76 take effect, we look forward to tracking and discussing the various implications of this new legislation. 

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