N.C. governor sets Medicaid expansion date, pressuring Republicans to act

North Carolina Gov. Roy Cooper’s administration on Wednesday announced the state will expand Medicaid on Oct. 1 — even though lawmakers have yet to approve the funding to do so.

The unusual move, agreed to by the Biden administration, puts additional pressure on the state’s Republican-controlled legislature to either pass a budget or fund Medicaid expansion separately — something the Democratic governor and his health and human services secretary, Kody Kinsley, have been calling for since lawmakers failed to reach a spending deal earlier this month.

“This is driven by my desire to try to get this going as fast as possible and to maximize the benefits for the people of North Carolina,” Kinsley said in an interview. “This makes it real for everybody, including the General Assembly.”

The state’s plan gives lawmakers until Sept. 1 to fund the proposal. State health officials said that by starting their work now, they can reduce the lead time needed to implement the program from 90 or 120 days after the legislature gives its final approval to 30 days.

If, however, lawmakers miss the September deadline, Medicaid expansion would be delayed until Dec. 1, health officials said.

North Carolina became the 40th state to approve Medicaid expansion in March, with more than 600,000 people expected to be eligible for the program when it takes effect.

Implementing Medicaid expansion has been a top priority for the two-term governor, who will leave office in 2025.

Republican lawmakers overcame years of opposition to approve the proposal but declined to fund it separately, wanting some leverage over Cooper as they hashed out the budget. In August, Cooper railed against lawmakers for tying expansion to the budget.

“Making Medicaid Expansion contingent on passing the budget was and is unnecessary, and now the failure of Republican legislators to pass the budget is ripping health care away from thousands of real people and costing our state and our hospitals millions of dollars,” Cooper said in a statement.

Lawmakers have shown no signs of budging — even though negotiations between House and Senate Republicans are on other issues, such as tax cuts and pay raises for state employees.

Rep. Donny Lambeth, a Republican and senior chair of the House Appropriations Committee, said Cooper knew that tying Medicaid expansion to the budget was part of the deal.

“He negotiated with us in good faith … He agreed, and now wants to change the agreement,” Lambeth said. “He knew the risk, so if he was not comfortable back in March, he should never have agreed to the deal.”

North Carolina lawmakers are on break and won’t return to Raleigh until Aug. 7. Lambeth said he believes there is a 50-50 chance lawmakers will resolve their outstanding budgetary issues when they return and approve their final conference report the week of Aug. 14.

There are “still a lot of policy issues to work out with the House and Senate conference committee,” Lambeth said. “Things are moving forward, but lots of work is still to be done.”

The announcement comes after 9,000 people who would have been eligible for health coverage under expansion were dropped from Medicaid as the state combs through its health insurance rolls to determine for the first time since the beginning of the pandemic whether millions of people are still eligible.