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North Carolina Gov. Josh Stein approved a $319 million plan Thursday to plug a funding gap for the state’s Medicaid program — a move that ensures continued healthcare for millions of North Carolinians. But Republicans and Democrats acknowledged that more work needs to be done to find a sustainable, long-term funding solution for a program grappling with rising costs
The bill, which becomes law immediately, passed both chambers of the General Assembly on Tuesday with strong bipartisan approval.
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Stein, a Democrat, has made Medicaid a top priority, pushing the Republican-led legislature to approve the funding amid an impasse over a broader state spending plan. Republican legislative leaders delayed approving the stopgap Medicaid funding as they sought to include cost-management measures in the bill
State officials have said the program was due to run out of money next month
“For months, the status of Medicaid in North Carolina has been in unnecessary jeopardy,” Stein said at a ceremony at the North Carolina Executive Mansion. “But I’m relieved to say that the bill that I will be signing will provide certainty and care that the people and the providers of this state need and deserve.”
Flanked by Republican and Democratic lawmakers, Stein added: “When it really matters, state leaders of both parties can come together and do the work of the people.”
Republican lawmakers agreed to approve the funding — but only with provisions that seek to control rising costs, including fraud-prevention measures and efforts to better vet Medicaid recipients for eligibility.
Republican lawmakers have raised concerns that the Stein administration’s health officials aren’t doing enough to catch or prevent fraud in the Medicaid system, and that the state’s Democrat Attorney General, Jeff Jackson, isn’t doing enough to prosecute fraudsters. Stein pushed back against those allegations Thursday.
“We are always trying to run it better,” he said. “We are committed to continually containing costs and eliminating fraud, waste and abuse at every turn.”
Stein had requested $500,000 to help Jackson bolster his team that sniffs out and prosecutes Medicaid fraud, but the legislature declined to fulfill that request and instead proposed giving $500,000 to Republican State Auditor Dave Boliek to hire new staffers dedicated to looking for waste inside the Department of Health and Human Services
“We have a dual responsibility in the General Assembly — one to the patients, two to the taxpayers — to deliver a healthier North Carolina with respect to the outcomes that are happening on the ground and outcomes are happening in the General Assembly with respect to our budget,” state Sen. Benton Sawrey, R-Johnston, said at Stein’s signing ceremony
He said the new law, House Bill 696, gives the state’s Medicaid partners tools to manage costs. “It gives them the ability to look at data,” he said. “It gives them the ability to help people make choices with respect to where healthcare is delivered, and it gives them the ability to look at better health outcomes for both taxpayers and for the patients.”
Despite opposition to measures that could delay or deny Medicaid coverage for some eligible recipients, Democratic lawmakers and Stein ultimately signed off on the bill because it lifts a cloud over healthcare for millions in the state.
“The 3 million neighbors on Medicaid can go about their daily lives with the peace of mind that they can get the healthcare that they need — when they need it — with insurance that they depend on,” Stein said. “And all of us will benefit from a stronger healthcare system as a result.”
Cost-management measures
Democratic lawmakers had raised concerns over provisions of the bill that threaten to eliminate coverage for some, including immigrant families. Democrats argue that the bill could revoke Medicaid coverage from more than 25,000 immigrants who are living legally in North Carolina — including victims of human trafficking and refugees.
“Depriving these vulnerable women and children of healthcare coverage is wrong,” Stein said Thursday, adding that he’s hopeful that Republican lawmakers would adjust the law to accommodate those recipients. Stein also took issue with other measures that could delay benefits at a time when rising healthcare costs are burdening North Carolinians.
Republicans say they’re complying with new federal rules backed by Republican President Donald Trump, but that they’re willing to consider changes if it turns out some of those people should be allowed to continue receiving care
The bill includes additional provisions intended to remove people from Medicaid coverage, such as stricter work requirements and income eligibility checks. Those would flag people who make too much money to qualify for Medicaid, as well as people who are able to find work.
House Speaker Destin Hall told reporters Tuesday he supports those measures because he thinks too many people are on the program, inflating its costs to taxpayers
“Somebody who can’t work, obviously, they’re going to qualify,” Hall said. “They’re going to qualify. But folks who just choose not to work because they want to smoke weed and play Xbox all day? Those are not the folks who need to be on Medicaid.”
The Medicaid funding plan also would force DHHS officials to turn over people to federal immigration officials if they discover that someone receiving Medicaid funding has a family member in their household whose immigration status is in question
Stein previously vetoed a separate bill to put similar requirements on many different government agencies, including DHHS. Republicans have so far been unable to find any Democrats willing to cross party lines on that issue and override Stein’s veto
Advocates for healthcare providers, meanwhile, lauded the approval Thursday. Josh Dobson, chief executive of the North Carolina Healthcare Association, called it “an important step forward.”
“By fully funding Medicaid and putting in place a responsible path on key financing issues, this bill provides stability for a system that millions of North Carolinians do really depend on every single day,” Dobson said.
Long-term plan
Republicans and Democrats acknowledged Thursday that more work needs to be done to come up with a sustainable funding solution for the program.
“There are headwinds and there are challenges with Medicaid in North Carolina in the foreseeable future,” said Sawrey, the Johnston County Republican. He estimated that Medicaid costs have almost doubled in the past five years and that the plan approved Thursday isn’t a
Medicaid “isn’t happening in a vacuum,” he said, noting that expenditures on the program affect other needs in the state. “That’s money that we could send back to the taxpayers in income taxes,” Sawrey said. “That’s money for state-employee raises. That’s investment in our colleges and community colleges. That’s investments in our state buildings and infrastructure and roads across the state.”
Sawrey said that while he was happy lawmakers were able to arrive at an agreement over this year’s funding, his party would work with lawmakers, Stein and state public health officials to find a solution amid rising healthcare costs.
“I don’t have any illusion that this is the current solution that’s going to fix everything going forward,” he said. “We’ve got more work to do.”
Stein said he was hopeful legislators would appropriate recurring funding — not one-off appropriations — to sustain the program.
“We can avoid this painful process every year, protect the program for those who rely on it and keep our entire healthcare system strong,” Stein said
Stein also acknowledged that cost management will be an ongoing effort. In addition to existing fraud and waste programs, “we also have to be clear eyed about the rising healthcare costs and commit to longer term actions to constrain them,” he said.
“Let’s work together as we contain costs for healthcare over the longer term,” Stein said. “That’s how we will ensure a sustainable program that keeps North Carolinians healthy.”
