iMedicaid Expansion Deal
Republican lawmakers held a press conference on Thursday to discuss Medicaid expansion. After months of talks, they announced they had finally reached an agreement. This announcement is the most recent action taken to increase access to health care for the state's working poor. Democrats have called for expansion for years, but Republicans opposed it until Senate Leader Phil Berger declared he had changed his mind last year, and many other GOP leaders did the same. Berger stated that they had reached an agreement in which some, but not all, of the extra provisions popular in the Senate would be included in the bill.
According to the law, healthcare providers must obtain state approval before expanding, purchasing large pieces of equipment, or offering new services. Hospitals fought any changes to the law vehemently. Berger called the Medicaid expansion agreement's certificate of need changes "the most significant modification" since the law's passage. The modifications include:
-
Removing the requirement for a certificate of need for behavioral health and chemical dependency beds.
-
Raising the threshold for replacement equipment to $3 million and indexing it to inflation.
-
Raising the diagnostic center threshold to $3 million and indexing it to inflation.
-
Removing the requirement for a certificate of need for MRIs in counties with a population of 125,000 or more.
-
Removing the requirement for an ambulatory surgical center certificate of need in counties with a population of more than 125,000 people.
Surgical centers that are exempt from the certificate of need provision will be required to have a 4% charity care requirement in counties with populations greater than 125,000. An annual charity care reporting requirement will be implemented. HASP (Healthcare Access and Stabilization Program) will go into effect immediately after the legislation is passed.
Low-income adults without dependent children who make too much money to be eligible for regular Medicaid but not enough to be eligible for subsidized insurance in the Affordable Care Act marketplace will benefit from expansion.
Under Medicaid expansion, the federal government will cover 90% of the cost for new enrollees, with state proposals calling for hospitals and insurance providers to cover the remaining 10%.
The federal government is also providing states with financial incentives to expand Medicaid if they have not already. North Carolina would be eligible to receive about $1.5 billion as one of the 11 states that have not taken action on expansion.
According to the agreement, Medicaid expansion would take effect upon the passage of the state budget which is expected this summer.
Read more about the bill from WRAL
Read more about the bill from The Pulse
Medical Marijuana Bill Proceeds to House
The North Carolina Senate voted 36-10 on Wednesday to legalize marijuana use for medical purposes, giving the idea strong bipartisan support for the second year in a row. Senate Bill 3 would establish a framework in which physicians could essentially prescribe marijuana to their patients if they believe the health benefits outweigh the risks. Patients with more than a dozen conditions, including epilepsy, amyotrophic lateral sclerosis (ALS), and post-traumatic stress disorder (PTSD), as well as those with terminal illnesses or receiving hospice care, may be eligible. The bill now goes to the state House, where a similar proposal stalled last year, despite bipartisan support in the Senate. House Speaker Tim Moore has said this year that the idea has some support in his chamber.
The SAVE Act Introduced
On Tuesday, nursing organizations and a bipartisan coalition of lawmakers launched their annual push to give advanced practice registered nurses (APRNs) more authority, a move they claim saves money by reducing unnecessary red tape in the healthcare industry. Lawmakers introduced identical versions of the bill in the Senate and the House, Senate Bill 175 and House Bill 218, and supporters predicted broad, bipartisan support in both chambers. APRNs with a master's degree and, in some cases, a doctorate, are currently required to have a supervising doctor before they can provide certain services to patients in North Carolina. The SAVE Act relaxes those restrictions. Doctors' groups are opposed to the bill, claiming that it jeopardizes patient safety. The North Carolina Medical Society said Tuesday that nurses are "essential members of a patient care team but are not trained to practice independently.”
CHANGES TO FOSTER-CARE SERVICES
A bill that would significantly alter state foster-care services has been re-filed by a group of Senate Republicans. The main goal of those modifications is to guarantee that children and young people in foster care can continue to receive Medicaid-covered physical and behavioral health services even if they are transferred to another county. Senate Bill 156 was introduced by Sen. Joyce Krawiec (R-Forsyth) on February 23. The bill contains language that is similar to that of House Bill 144, which passed the Senate with a 41-0 vote during the 2022 session but was not taken up by the House. Under Senate Bill 156, the six behavioral health managed care organizations (MCOs) for the state have a significantly reduced role. A clause requiring MCOs to create and maintain a closed network of providers to offer enrollees services for mental health, intellectual or developmental disabilities, and substance abuse was eliminated as well as a clause that prohibited organizations with a common ownership from submitting more than one bid was also removed.
2023 Tax Cuts
Because of higher-than-expected revenue projections, Republican state lawmakers say they want to consider tax cuts this year. Fears of an impending economic downturn prompted lawmakers to abandon tax-cut plans last year. However, new revenue projections released this month show a potential $3 billion surplus — roughly 10% of the state's total budget. According to state government economists, this is due to high corporate profits and consumer spending. Democrats, on the other hand, oppose the strategy. They introduced Senate Bill 142 and House Bill 165, last week to repeal corporate income tax cuts that are set to take effect in 2025. By 2030, current legislation would completely eliminate the current 2.5% corporate tax. The bills are sponsored by Sen. Lisa Grafstein (D-Wake) and Rep. Marcia Morey (D-Durham) and are titled "Make Corporations Pay Their Fair Share." The bills are unlikely to be heard in the Republican-controlled legislature.
