A massive looming purge should spur NC to expand Medicaid now | Opinion

If you count all the people who would benefit, there are more than a half-million reasons to expand Medicaid in North Carolina.

Now, here’s another one. It’s called Medicaid unwinding.

A federal pandemic relief measure gave states extra Medicaid funding but barred them from dropping recipients when changes in their circumstances made them ineligible. There’s usually a churn in the Medicaid population, but the continuous coverage requirement swelled the state’s Medicaid recipients from 2.1 million in March 2020 to 2.9 million last month, but it will expire on March 31. That could cause up to 300,000 of the state’s Medicaid recipients to be dropped from the program by the end of next year.

The unwinding makes it even more urgent to expand Medicaid now. The terms of expansion would sharply raise the state’s Medicaid income eligibility levels from just below 40 percent of the federal poverty level to 138 of the federal poverty level. That would allow more of those facing removal because, for instance, they are no longer pregnant or their income has risen, to remain on the state and federal health insurance program.

Prospects for expansion brightened last week when the Republican-controlled state House voted 92-22 to expand Medicaid. Yet approval by the state Senate is not assured.

Senate leader Phil Berger wants to yoke expansion to easing state regulations on medical caregivers and new medical facilities. The House majority wants a “clean” expansion bill without the regulatory changes. The disagreement hung up expansion when it seemed imminent last year. Now it could delay approval again, even as a Medicaid purge looms.

Leighton Ku, a health policy researcher and public policy analyst at George Washington University who has documented the advantages of expansion in North Carolina, said the state needs to act quickly.

“This is an especially important time for North Carolina to try to adopt expansion soon so they don’t go through cutting hundreds of thousands people off and then the following year bring hundreds of thousands people on. That would be sort of a silly thing to do,” he said.

Medicaid covers parents, children, pregnant women, the elderly and the disabled. Currently in North Carolina, childless adults are not eligible, but they would be under expansion. The federal government pays about two-thirds of the program’s cost with the state covering the rest.

Losing hundreds of thousands of current Medicaid recipients without expansion will threaten the viability of health care providers, like rural hospitals and community health centers, who serve these patients, Ku said.

The federal government, seeking to coax the last 11 states that haven’t expanded Medicaid to do so, is offering extra payments that will more than cover the states’ share of expansion’s cost for two years. North Carolina would actually make a profit on the deal.

That sweetener comes on top of the fundamental advantages of expansion. It would create tens of thousands of jobs, keep rural hospitals from closing and improve the health and quality of life for as many as 600,000 North Carolinians, most of them in working families, who would become eligible.

Getting those benefits is now up to the Senate, but an agreement does not appear near. When asked about the House bill that approves expansion without regulatory changes, Berger told reporters it was “not the bill that we need in North Carolina expanding Medicaid.”

It’s time for Senate Republicans to give up on gamesmanship. Changes in state medical regulations can be dealt with separately.

For a decade, Republicans have blocked expansion at a cost of billions of dollars in federal support foregone and hundreds of thousands of North Carolinians deprived of the care and peace of mind that comes with being insured.

Associate opinion editor Ned Barnett can be reached at 919-829-4512, or nbarnett@ newsobserver.com

Correction: An earlier version of this column misstated the upper income threshold for Medicaid eligibility under Medicaid expansion. It is 138 percent of the federal poverty level., not 138 percent above it.