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North Carolina approves Medicaid expansion, reversing its long opposition

A Medicaid expansion deal in North Carolina received final legislative approval on Thursday, ending a decade of debate over whether the closely politically divided state should accept the federal government's coverage for hundreds of thousands of low-income adults.

North Carolina is one of several Republican-led states that have begun considering expanding Medicaid after years of steadfast opposition. South Dakota voters approved expansion in a referendum in November. And in Alabama, advocates are urging lawmakers to take advantage of federal incentives to expand Medicaid in order to provide health insurance to thousands of low-income people.

When North Carolina's Democratic governor, Roy Cooper, a longtime expansion advocate, signs the bill, it will leave 10 states in the U.S. that haven't adopted expansion. North Carolina has 2.9 million enrollees in traditional Medicaid coverage. Advocates have estimated that expansion could help 600,000 adults.

"Medicaid Expansion is a once in a generation investment that will make all North Carolina families healthier while strengthening our economy, and I look forward to signing this legislation soon," Cooper tweeted.

The state House voted 87-24 in favor of the deal, after little debate. Some members clapped after it passed, which is usually not permitted under chamber rules. The North Carolina state Senate approved the legislation last week.

The final agreement also included provisions scaling back or eliminating regulations that require state health officials to sign off before medical providers open certain new beds or use equipment. Senate Republicans demanded the "certificate of need" changes in any deal.

Republicans in charge of the General Assembly for years had been skeptical about expansion, which originated from the 2010 federal Affordable Care Act. But they have come around to the idea over the past year, deciding that Congress was neither likely to repeal the law nor raise the low 10% state match that coverage requires.

And a financial sweetener contained in a COVID-19 recovery law means North Carolina also would get an estimated extra $1.75 billion in cash over two years if it expands Medicaid. Legislators hope to use much of that money on mental health services.

There's no set start date in the law for expansion under the legislation, but it also comes with one caveat: It can't happen until after a state budeget is approved. 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.

The state's 10% share of expenses for Medicaid expansion recipients would be paid through hospital assessments. Hospitals also are expected to receive larger reimbursements for treating Medicaid patients through a federal program the state is requested to include in the legislation.

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