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Gov. Cooper officially signs Medicaid expansion into law

Medicaid expansion was agreed on by Republican lawmakers earlier in March, and the General Assembly passed the legislation last week.

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RALEIGH, N.C. — Gov. Roy Cooper officially signed Medicaid expansion into law on Monday at the Governor's Mansion in Raleigh.
Cooper was surrounded by lawmakers as he signed the legislation, which the General Assembly passed last week after reaching an agreement earlier in March.

“This law, once implemented, will be the working families bill of the decade,” Cooper said. “Today is a historic step toward a healthier North Carolina.”

The plan is to tie expansion to the state budget, which is expected to become law this summer or fall. If all goes according to plan, about 600,000 North Carolinians will be able to finally get health insurance by the end of this calendar year.

North Carolina currently has 2.95 million Medicaid enrollees, but Cooper said many others suffer in a health care coverage gap, having to ignore treatable and preventative illnesses.

“While a solution sat just out of reach, with this law I’m about to sign, many of them will be close enough to grab it,” Cooper said, standing next to House Speaker Tim Moore, Senate leader Phil Berger and other expansion supporters.

The two legislators earlier this month finalized a negotiated agreement that contains expansion and looser “certificate of need” regulations on health care facilities before they can open more beds or use expensive equipment. The House and Senate approved the deal separately, with the final vote happening Thursday.

Republicans in charge of the legislature had for years knocked down the expansion idea that originated from the 2010 Affordable Care Act. That led to litigation against Cooper and budget impasses between them.

But GOP leaders reversed themselves in recent times, convinced that the state’s Medicaid program was fiscally sound with a switch to managed care, and that Congress would neither repeal the 2010 law nor raise the state's 10% required share of expenses.

“Now we have a Medicaid system that is stable,” Berger said. “By transforming our state’s Medicaid program, we’re now in a place where our system can handle those additional

The measure contains a provision that Cooper opposed requiring a separate state budget law to be enacted first for expansion to be accepted and implemented. That makes an enrollment start date unclear and gives the GOP leverage in upcoming negotiations.

“While a solution sat just out of reach, with this law I’m about to sign, many of them will be close enough to grab it,” Cooper said, standing next to House Speaker Tim Moore, Senate leader Phil Berger and other expansion supporters.

Requiring the budget's passage for expansion provisions to be enacted means Republicans could fill the budget bill with unrelated items that Cooper opposes. Republicans are now just one House lawmaker shy of holding veto-proof control at the General Assembly.

“I feel confident that we can work together to get something that we can agree on,” Cooper told reporters after the signing, adding that expanding Medicaid if now a question of “when” and not “if.”

Monday's legislation directs the state's expansion expenses be paid with hospital assessments. Hospitals also will get money for treating Medicaid expansion patients, and the law will enter them into a federal program for larger reimbursements.

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