North Carolina Medicaid expansion will not launch by the program’s much-anticipated Oct. 1 kickoff, likely falling into December or sometime in 2024 due to lawmakers’ ongoing struggles to pass a state budget, according to Kody Kinsley, secretary of the North Carolina Department of Health and Human Services.
“As we’ve come into this final week of August,” Kinsley said in a press conference Monday, “it’s become clear to us that we will not be able to have a budget passed in time and enacted nor will we have separate authority to move forward and so we will not be able to go live with expansion at this time, Oct. 1.”
When North Carolina’s Republican-majority legislature passed Medicaid expansion in March, it tied the program’s enactment to successful passage of a state budget, which lawmakers hoped to complete by the end of June. But the state House and Senate have not yet reached a budget compromise.
“This is a tragic loss of health insurance for nearly 300,000 people that would have coverage on day one, delaying something that we know they and their families need so badly,” Kinsley said. “It’s also tragic for the near 9,000 North Carolinians that lose coverage every month due to the public health emergency unwinding, who would be able to stay on if Medicaid expansion was in place.”
DHHS, a Cabinet agency of Democratic Gov. Roy Cooper, estimates expansion will open the door for more than 600,000 North Carolinians to gain health insurance through this state-federal government program. With the end of a federal pandemic relief rule that required states not to kick people off of Medicaid, DHHS has begun disenrolling thousands on Medicaid who are no longer eligible.
Tied to the budget
Both chambers of the General Assembly have a Republican supermajority, which allows them to pass laws favored by their party and to override Cooper’s vetoes, unless internal disagreements stifle the party’s unanimity.
A biennial state budget is supposed to be passed on every odd-numbered year by June 30, but delays are common. This year, lawmakers have struggled to find a compromise. According to top Republican leadership in both chambers, a budget will not pass by Sept. 1, with a likely drop date in mid-September.
On July 25, DHHS announced it would move forward with Medicaid expansion while waiting on a state budget deal, with a start date set for Oct. 1, dependent on a budget being passed by Sept. 1. DHHS said at the time that it had worked with the federal Centers for Medicare & Medicaid Services to start sending required public notices for beneficiaries, counties and providers on Sept. 1.
This early work, according to DHHS, would allow the state to shorten Medicaid expansion’s implementation period upon receiving legislative authority to about 30 days instead of the typical 90 to 120. In July, DHHS said it would have to delay expansion plans until December or later if a budget did not pass by the start of September, or if legislators did not separate Medicaid expansion from the budget.
Senate Democratic Leader Dan Blue and House Democratic Leader Robert Reives, shortly after the DHHS presser on Monday, said in a joint written release that “North Carolinians have been waiting for Medicaid expansion for a decade. Because of Republicans’ ongoing budget delay, that wait continues with no end in sight.”
“This General Assembly’s failure to enact a budget, and therefore expand Medicaid, is having a severe impact on people who rely on that care or who will benefit when it is expanded,” the two lawmakers said. “For many people, this is genuinely a matter of life and death. It is long past time for Republican leaders to come back from vacation and get to work.”
Asked why, if a budget were passed by mid-September or another date in the near future, Medicaid expansion could not be implemented in 30 days instead of by December or later, Kinsley said “there’s really several variables we have to determine right now.”
“Depending on how far it slips for them to give us the final authority to move forward, it could be December at the earliest, it could slip into 2024,” he said. “We’re going to work to try to make that happen as soon as possible. But again we need their thumbs-up to move forward.”
Pressed further, Kinsley said there were a number of issues that had to be managed, including quarterly cash flow issues and important technology changes for enrollment, beneficiary notifications and more.
“The next 30-day period is different from the last 30-day period,” Kinsley said. “There are different obstacles. We continue to look at those closely.”