GOP-led N.C. legislature expands Medicaid, still may dicker with Democratic governor; other states seeing action

State Rep. James Roberson takes a picture with fellow House Democrats on the chamber floor after the House gave final approval to a Medicaid expansion agreement in Raleigh, N.C., on Thursday, March 23. (AP photo by Gary Robertson)

"The North Carolina legislature sent Gov. Roy Cooper on Thursday its proposal to expand Medicaid for an estimated 600,000 adults, a move cheered by Medicaid advocates who hope the movement could spread to the remaining 10 states" that haven't expanded, reports Dorothy Mills-Gregg of Inside Health Policy. Cooper, a Democrat with a Republican legislature, said he would sign the bill.

The expansion is expected to have a big impact in rural North Carolina. The state had almost 3.5 million rural residents in the 2020 census, one-third of its total but second only to Texas' 4.74 million.

The bill does not set a date for the expansion, but "It can’t happen until after a state budget is approved," notes Gary D. Robertson of The Associated Press. "This usually happens in the early summer. Cooper panned that provision, which could give GOP leaders leverage to include unrelated items he may strongly oppose. . . . North Carolina is one of several Republican-led states that have begun considering expanding Medicaid after years of steadfast opposition. Voters in South Dakota approved expansion in a referendum in November."

Republicans in North Carolina and many other states have tried to require work of "able-bodied" Medicaid beneficiaries, but the Biden administration has resisted that. North Carolina's bill requires the state "to work with a workforce development case manager that assesses Medicaid beneficiaries’ employment status and barriers to employment," Mills-Gregg reports.

The bill also directs the state to work with the Centers for Medicare and Medicaid Services to add work requirements to the program, but the Biden administration has "managed to revoke all Trump-era work requirement waivers except for Georgia’s requirement, which survived after a federal judge ruled CMS failed to recognize that Georgians would actually gain coverage under the state’s partial Medicaid expansion," Mills-Gregg notes. "The Biden administration decided not to appeal the ruling." Georgia's expansion takes effect in July.

UPDATE, March 24: Politico Pulse reports on other holdout states: "Kansas Gov. Laura Kelly, a Democrat, continues to press for Medicaid expansion this year and included funding for the policy in her budget. The state’s GOP-controlled legislature, however, remains skeptical. Expansion proponents in Wyoming were hopeful they’d be able to pass the policy this year. A bill passed out of committee in January, but the proposal died on the House floor without a vote. And expansion advocates had their hopes crushed in Mississippi on Thursday after a bill that would have restored the state’s ballot measure process — thereby giving Medicaid expansion a shot at the ballot box — died amid disagreements between the House and Senate." Most holdouts are in the South.