A few days after the rate cuts for Medicaid providers to take effect on October 1, Republican leaders in the General Assembly are unable to agree on a solution to fund Medicaid in North Carolina.
“Without an agreement in sight for finance “By completely eliminating our Medicaid program, the General Assembly is shutting down access to health care just when we need it most,” North Carolina Governor Josh Stein said in a press release.
¿What is the main disagreement between the Senate and the House of Representatives?
Both chambers agree that more Medicaid funding is needed, with the Senate passing the HB 562, which adds $90 million to the previously funded $600 million.
“What we're asking for in the House is a clean Medicaid bill that secures at least that minimum $690 million in funding, which both Governor Stein and the Secretary have indicated they can work on through the end of the year and reassess the additional funding that will be needed,” he continued.
“The initiative includes a total of $690 million for Medicaid realignment, plus some additional items the House hasn't agreed to, such as $100 million for Children's Hospital,” Sarah Crawford (D-Wake) said at a press conference Monday.
Related: North Carolina Republicans reject Stein's special session to fund Medicaid
Children's hospital, without agreement
If passed, the bill would also provide $103,5 million in support for North Carolina Children's Hospital and $105 million for the North Carolina Care Initiative.
This is where Republican leaders in the Senate and House of Representatives disagree: funding for other health-related initiatives, such as the Children's Hospital and the North Carolina Care Initiative.
On Tuesday, September 23, the House of Representatives approved the SB 403, which allocates $192 million in additional funding for Medicaid and eliminates vacant positions in the state health department to offset the remaining funding gap. The plan would not fund either of the two health-related initiatives.
“They are allowing a separate disagreement between the chambers to scuttle this crucial funding,” Stein said.
“They are putting their politics before our people. It's inexcusable. I urge the legislature to put aside their differences and protect North Carolinians' access to health care,” he said.
However, lawmakers adjourned with no firm plans to return for further votes on Medicaid funding before October 1.
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Democrats urge clean Medicaid law
On Monday, 22 Democratic leaders held a press conference urging their Republican counterparts to cooperate on Medicaid funding.
“We must pass a clean bill to fully fund Medicaid and protect provider rates,” Julia Greenfield (D-Mecklenburg) said during the press conference.
"My Democratic colleagues and I are ready. I ask my Republican colleagues to join us," he said.
Greenfield explained that when former Governor Roy Cooper signed the law into law Medicaid expansion In 2023, it provided access to healthcare to 650,000 people who had previously been denied it.
However, this progress is threatened at the state level.
“Republicans are not doing their job to fund the Medicaid program they ultimately voted to expand in 2023,” Greenfield explained.
“And I want to be very clear about this: Republicans control everything. … We must continue to defend the expansion we fought for, which now covers more than 650,000 North Carolinians. We need Republicans to join us,” she said.
Related: 10 key facts about Medicaid expansion in North Carolina that you may not have known
Medicaid, “a vital resource”
Rodney Pierce (D-Halifax) said at the press conference that in Halifax County, 45% of residents are enrolled in Medicaid, in Northampton, 41%, and in Warren, 35%. The majority of beneficiaries are females between the ages of 6 and 18.
“Medicaid isn't just a policy for us in rural North Carolina, it's a vital resource,” Pierce said.
“Rural residents often have to travel long distances just to see a specialist, because in many cases, those services don't even exist where we live,” he added.
The legislator indicated that if "these cuts are approved, our rural hospitals, which already operate on very tight profit margins, could be forced to close permanently."
Republican leaders disagree
For his part, Republican Representative Donny Lambeth (R-Forsyth) explained that the House version of the Senate bill is clean.
“We’re not manipulating it. Our colleagues across the street have added other items to their Medicaid solution that are budget negotiation items. We don’t have to deal with that,” Lambeth said as he introduced the bill in the House of Representatives.
“Frankly, we couldn't agree to the Senate version, which added other things we were simply not comfortable with,” he said.
However, on Monday in the Senate, both Republicans and Democrats agreed on the Medicaid funding package, and explained why funding for Children's Hospital is necessary.
“It’s not just about convenience, continuity, or availability of care, but about cost,” said Republican Senator Kevin Corbin (R-Macon).
“If there's a children's hospital in North Carolina, one that's in-state for most insurers, that's in-network, that makes a big difference for many families.”
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Uncertain future of Medicaid
After Tuesday's vote, House Speaker Destin Hall, a Republican, said the Duke and UNC health systems are in good financial standing, so lawmakers aren't comfortable funding a children's hospital project at a time when rural hospitals are struggling.
“We have UNC-run hospitals across the state, particularly in rural areas, that could use some of those capital funds,” Hall explained.
The disagreement between the chambers leaves the future of Medicaid uncertain at a time when there isn't enough federal money to fill the program's funding gaps in the state.
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