North Carolina state legislature passes Medicaid expansion

The North Carolina General Assembly on Thursday passed a bill to expand Medicaid eligibility to include nearly all adults who make less than 133 percent of the federal poverty level, moving the state closer to becoming the 40th state to adopt Medicaid expansions provided through the Affordable Care Act.

The North Carolina House of Representative passed the bill on Thursday in a 87-24 vote. Gov Roy Cooper (D-N.C.) has already stated he will sign the bill once it reaches his desk.

“Medicaid Expansion is a once in a generation investment that will make all North Carolina families healthier while strengthening our economy, and I look forward to signing this legislation soon,” Cooper said on Twitter.

Unlike many other states that have expanded Medicaid, North Carolina was notable for expanding the program through legislation instead of through a ballot measure.

Supporters of Medicaid expansion in North Carolina have estimated up to 600,000 people could benefit. The passage of this bill coincides with the 13th anniversary of when the ACA was signed into law.

Once the bill is signed, there will only be 10 states left that have not expanded Medicaid: Wyoming, Kansas, Texas, Wisconsin, Tennessee, Mississippi, Alabama, Georgia, South Carolina and Florida.

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North Carolina stands to receive some generous financial incentives for adopting Medicaid expansion. The American Rescue Plan included enhanced federal matching rates for states that newly expand Medicaid, reimbursing states for 90 percent of their Medicaid expenditures for the first two years.

The provisions of the bill will go into effect at the start of 2024 and county social services departments can begin accepting applications from eligible individuals beginning as soon as December of this year.

The vote also comes not long before the national public health emergency for COVID-19 officially ends and the continued Medicaid enrollment provisions begin to unwind.

Health stakeholders have warned that the gaps between states with and without Medicaid expansion would become starker, and that millions of Americans risk losing Medicaid.