NC lawmakers approve deal to save Medicaid funding for 3 million North Carolinians

North Carolina lawmakers finalized a $319 million plan Tuesday to fully fund the state’s Medicaid program before sending it to Gov. Josh Stein’s desk for his final approval.

The plan passed in initial votes last week that were near-unanimous. And after some Democrats raised some concerns Tuesday over pieces of the bill, particularly how it would treat some immigrant families that may no longer qualify for Medicaid, the support remained broadly bipartisan. It passed 112-3 in the state House and 45-3 in the state Senate.

Stein’s office has so far not commented on the bill except to say he supports funding Medicaid but is still reviewing other parts of it.

A former Democrat, Rep. Carla Cunningham of Charlotte, criticized her colleagues who spoke up Tuesday for focusing on the wrong constituents. Cunningham lost her primary last month after voting with Republicans on several politically contentious bills, including on immigration, and several days ago she quit the Democratic Party to re-register as an unaffiliated voter.

On Tuesday, she said Republicans wrote the language targeting immigrants into the bill to avoid drawing the ire of President Donald Trump's administration, which could potentially decide to stop paying for the Medicaid Expansion program that serves 700,000 people in North Carolina. Medicaid Expansion receives no state funding. The Medicaid program as a whole, which is funded by the state and federal governments, serves more than 3 million people.

Rep. Pricey Harrison, D-Guilford, had raised concerns that the changes could lead to thousands of immigrants in North Carolina, who are in the country legally, being kicked off Medicaid. Cunningham said that she was more concerned by what the federal government would do if North Carolina doesn't change those rules.

"Now we hear all about these other folks," Cunningham said. "I'm not talking about other people. I'm talking about 700,000 citizens that got drew up on the Medicaid expansion. That's who I'm worried about. Who are you worried about?"

However, some Republicans later said Harrison's concern wasn't without merit, and that they'd look into whether some immigrants would be wrongfully kicked off their coverage, and if changes needed to be made.

"Your part about the 27,000, Representative Harrison, who lost their health care, hasn't fallen on deaf ears," said Rep. Larry Potts, R-Davidson, a top health care policymaker. He added that it's possible the legislature will consider "a series of bills" addressing other Medicaid issues in the coming months.

Stein has made Medicaid funding a top political issue for months, hammering Republicans for not immediately approving funds for the program that provides health care for more than 3 million North Carolina residents.

State health officials say Medicaid is on track to run out of money in May, unless this new plan is approved before then. Because the legislature hasn’t passed a new state budget, Medicaid is running on years-old numbers that don’t account for the state’s population growth or inflation in recent years.

The hesitance from Stein and some legislative Democrats to fully embrace the GOP Medicaid funding plan could be due in part to additional pieces of legislation Republican leaders added to the bill.

In addition to the immigration piece, the bill includes other new provisions intended to kick people off Medicaid, such as stricter work requirements and income eligibility checks. Those would catch people who make too much money to qualify for Medicaid, as well as people who aren't truly unable to find work. House Speaker Destin Hall told reporters Tuesday he stands by that wholeheartedly.

"Somebody who can't work, obviously, they're going to qualify," Hall said. "They're going to qualify. But folks who just choose not to work because they want to smoke weed and play Xbox all day? Those are not the folks who need to be on Medicaid."

And while Stein had also requested $500,000 to help Democratic Attorney General Jeff Jackson bolster his team that sniffs out and prosecutes Medicaid fraud, the legislature declined to fulfill that request and instead proposes giving $500,000 to Republican State Auditor Dave Boliek to hire new staffers dedicated to looking for waste inside the Stein administration’s Department of Health and Human Services.

“Billions of dollars flow through Medicaid in North Carolina,” Boliek wrote on social media last week. “Prior reports from our office have already uncovered improper payments and provider issues. The legislature's passage of new funding and Medicaid oversight directives for the State Auditor's Office provides our team with additional resources to investigate Medicaid dollars, and bring transparency and accountability to one of the largest government programs in our state.”

The Medicaid funding plan also would force DHHS officials to turn over people to federal immigration officials if they discover that someone receiving Medicaid funding has a family member in their household whose immigration status is in question.

Stein previously vetoed a separate bill to put similar requirements on many different government agencies, including DHHS, and Republicans have so far been unable to find any Democrats willing to cross party lines on that issue and override Stein’s veto.