A tentative Oct. 1 launch date for Medicaid expansion in NC depends on legislative action

Published July 26, 2023

By Lynn Bonner

North Carolina could launch Medicaid expansion on Oct.1 if the legislature acts by Sept. 1, the Department of Health and Human Services said Wednesday. 

The state legislature approved Medicaid expansion in March, but tied it to passage of the state budget. 

The new state budget year started July 1, but Republican House and Senate budget negotiators have not agreed on a final spending plan.

Gov. Roy Cooper’s administration has been itching to move on Medicaid expansion, which is expected to offer an additional 600,000 North Carolinians a chance to obtain health insurance. DHHS Secretary Kody Kinsley said in an interview Wednesday that 300,000 of those residents will have full Medicaid benefits on the first day because they’ll be moved from insurance programs with limited benefits. 

DHHS and the federal office that oversees Medicaid, the Centers for Medicare & Medicaid Services, agreed that the state can move forward with actions such as posting public notices and gathering public comment that usually don’t happen before official authorization. 

In its preparations for Medicaid expansion, DHHS built its plan with the expectation that the state budget would be on time.

“We have organized our work around the understanding that the General Assembly would have a budget passed by June 30,” Kinsley said. “That was what we had been speaking with them about.” 

DHHS wanted to keep moving toward implementation, but was held up by the budget delay.

“We had arrived at the gate with our bag packed, and the plane wasn’t there,” he said. “We had to figure out how can we continue our momentum and continue our work to get Medicaid expansion as soon as possible.”

Without the ability to keep moving, it would take between 90 and 120 days for Medicaid expansion to launch after the legislature acts. The implementation period could now be as short as 30 days. 

Republicans have so far ignored requests from Cooper and House Democrats to separate Medicaid expansion from the budget.

The senior House budget writer said earlier this month that a budget agreement may come in mid-August. The legislature did not meet last week and will not meet this week. 

Kinsley said he reached out to legislative leaders and the leaders of legislative health committees last week about the plan to continue moving toward implementation. 

“I have been working closely with leadership on Medicaid expansion for some time now,” Kinsley said. “I’m a no-surprises kind of person. I’m glad for us to be moving forward.”

Spokespersons for House Speaker Tim Moore and Senate leader Phil Berger did not respond to emailed inquiries. 

The legislature would have to pass a budget by Sept. 1 or “de-couple” Medicaid expansion from the budget by that date for expansion to launch on Oct. 1.

If the state does not have final authority to expand Medicaid by Sept. 1, the earliest fallback date is Dec. 1, DHHS said. The launch could be pushed to next year, depending on the timing of legislative action.