NC House Republicans want the state to negotiate for a Medicaid expansion work requirement

A NC House Republican proposal for Medicaid expansion would require the state’s health department to negotiate for a work requirement for enrollees before the question of offering health insurance to low-income adults comes to a vote of the legislature.

A new committee of House members and senators, called the Joint Legislative Committee on Medicaid Rate Modernization and Savings, would decide on Dec. 15 whether the state Department of Health and Human Services’ expansion plan meets criteria set out in Senate bill 408. If the joint committee decides the plan checks all boxes, the legislature would vote on it. House Speaker Tim Moore said the House would vote before the end of the year on an expansion plan that made it through the new joint committee.

House Speaker Tim Moore and Rep. Donny Lambeth discuss the future for Medicaid expansion.


“I think we’re at a good point right now where we have something that we can address some really critical needs, and we can do so in a way that is fiscally responsible to the taxpayers of the state,” Moore told the House Health Committee on Thursday morning.  “I don’t want to see us do anything as a General Assembly that would incentivize a person or persons from not getting a job.”

A different legislative committee of House members and senators that met earlier this year heard that many people who would gain health care coverage under Medicaid expansion already work but have jobs that do not offer health benefits.

Rep. Carla Cunningham, a Charlotte Democrat, said she was encouraged House Republicans were talking about expansion, but was underwhelmed by a proposal that would further delay it.

“Another study? I’m not down for another study,” Cunningham said. “We’ve been carrying this ball and chain around for 10 years.”

North Carolina is one of a dozen states that has not expanded Medicaid. The hold-out states have a new financial incentive to expand, which for North Carolina would mean about $1.5 billion over two years.

Medicaid expansion has become a major point of disagreement between House and Senate Republicans as the legislative session slowly winds down. The Senate overwhelming passed Medicaid expansion last month. 

The Senate proposal would also give registered nurses with advanced degrees the ability to work without doctors’ supervision and would loosen state regulations governing approval of new health care facilities and major medical equipment.

Medicaid expansion in North Carolina would cover about 600,000 adults who make too much to qualify for Medicaid but too little to qualify for subsidized commercial health insurance offered under the Affordable Care Act. Most adults without dependent children do not qualify for Medicaid. Parents must have very low incomes to qualify.

The federal government pays 90% of the cost of people with health insurance under expanded Medicaid. In proposals the legislature has considered over the years, hospitals would pay the other 10% of the cost.

The Biden administration has withdrawn permission for Medicaid work requirements in states that had them, and courts have dismissed state appeals.

Moore said after the committee meeting that under the House proposal, the Cooper administration would have to try to negotiate a work requirement. If that doesn’t fly, the plan must include something about work, he said. “There are no poison pills in here,” he said.

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NC House Republicans want the state to negotiate for a Medicaid expansion work requirement