Medicaid expansion is back on the table in the North Carolina General Assembly, with a new bill filed by House Republicans that would extend health care coverage to an estimated 600,000 people.

North Carolina got as close as it's ever come last year to expanding Medicaid coverage when Senate Republicans, long opposed to expansion, changed their tune. The Senate passed a bill that would expand the program last year, but it never made it through the House. 

What You Need To Know

  •  Republicans in the North Carolina House filed a new bill to expand Medicaid in the state

  •  Medicaid expansion passed the North Carolina Senate last year but negotiations stalled in the House

  •  Expansion would give health care to an estimated 600,000 people in North Carolina

  • North Carolina is one of 11 states that has not expanded Medicaid since it became an option in 2014

The new proposal, House Bill 76: Access to Healthcare Options, would give Medicaid coverage to people making 138% of the federal poverty level. That’s less than $32,000 for a family of three. It would also have the state join the federal Healthcare Access and Stabilization Program, which could fund rural health programs.

But the House bill is different from what the North Carolina Senate hashed out last year. There are some important differences. It does not include changes to the certificate of need program, long a target of Republican lawmakers. That program requires hospitals to get state approval to expand or add new equipment like MRI machines.

The House bill also does not include a work requirement for Medicaid. Work requirements in other states have been found unconstitutional when challenged in court. Instead, the House bill includes incentives to get people in job training and workforce development programs.

“Passing Medicaid expansion and HASP is a bipartisan issue. Members of all political parties want communities that are healthy and hospital doors that are open,” said Steve Lawler, president of the North Carolina Healthcare Association.

“We look forward to continuing to work with members of the General Assembly to make this a good bill that will help hundreds of thousands of our neighbors, and that we can all point to with pride,” he said.

Thirty-nine states and the District of Columbia have expanded Medicaid since it became an option in 2014 as part of the Affordable Care Act, also known as Obamacare.

Of the 11 states that have not expanded the program, most are in the South, according to the Kaiser Family Foundation.

Democrats in North Carolina have long argued for expanding Medicaid, but until last year the Republicans in control of the General Assembly opposed the idea.

Explaining his change of heart last year, Senate President Pro Tem Phil Berger said, “Medicaid expansion has evolved to a point where it is now good fiscal policy.”

He said the program has survived numerous legal challenges and the federal government has kept its promises to continue funding expansion. There’s also an offer from the federal government to pay North Carolina an extra $1.8 billion to expand the program.

“We must do something to improve health care, especially expand access and lower costs,” Berger said in May 2022. “We need coverage in North Carolina for the working poor.”

Medicaid expansion has a long way to go in the legislature before it could become a reality. The bill will have to work its way through the House and, if it can pass, it would head to the Senate where Republican leaders have already shown they have different ideas about what Medicaid expansion should look like.