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 members decline to gamble on ‘predatory’ sports wagering bill (w/ video)

Supporters of sports gambling failed to advance legislation in the state House Wednesday that would have authorized online sports wagering for North Carolina. The vote against Senate Bill 688 came after lawmakers narrowly approved a companion bill (SB 38) of sports wagering amendments.

But without both piece of legislation getting a joint nod from the House, it’s unclear what avenue bill sponsors will take in the waning days of the summer session.

Rep. Pricey Harrison (D-Guilford) said other states that have gone down this road have not had the payday they anticipated.

“The house is always going to win. North Carolinians are not going to win with this bill, and the argument that there’s offshore betting now and we should just do it and get the revenue, we know that offshore betting is going to continue because those companies are going to avoid paying the taxes and fees they are going to have to pay to do legalized betting.

“So, we’re not achieving anything except robbing North Carolinians of lots of money and funding the gambling industry. And we’re gonna have a lot of heartache and a lot of expense to our state and our taxpayers, and I can’t believe anybody can vote ‘yes’ for this bill.”

Rep. Pat Hurley (R-Randolph) was among more than 30 Republican members to join Harrison in opposing the fast-moving legislation, which cleared two committees earlier on Wednesday.

“Conservative estimates suggest North Carolina can expect to see tens of thousands more of our state’s citizens and their families being victimized by gambling addiction,” Hurley said. “What some people don’t even think about [it] adds to our social service budget.”

Rep. John Autry (D-Mecklenburg) dealt the bill another blow by successfully running an amendment that removed all college sports betting from the measure.

Rep. Jason Saine (R-Lincoln), the chief proponent of the bill in the House, is now looking for another approach to legalize sports betting before the end of the session.

SB 38, the companion bill that did win approval on Wednesday, faces one more vote in the House before heading back to the Senate.

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