North Carolina’s lingering budget talks mean the state won’t hit an Oct. 1 start date for Medicaid expansion, meaning a delay for hundreds of thousands of people poised to receive the taxpayer-funded health insurance, Secretary of Health and Human Services Kody Kinsley said Monday.
Kinsley’s department has said for some time that, to hit that start date, state lawmakers needed to pass the state’s new budget by Sept. 1. Some lawmakers had hoped recent movement in months-long budget negotiations, which are expected to yield a final budget in the next two weeks or so, would leave enough time for the state to coordinate an Oct. 1 start of expansion with the federal government, which would fund the lion’s share of expansion costs.
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Kinsley said in a statement Monday that it won’t, and his department said a new launch target won’t be set until lawmakers finalize the budget. That’s expected to happen the week of Sept. 11, and top lawmakers are hammering out final details now, according to state legislative leaders.
Even under that timetable, expansion may not go live until Dec. 1, Kinsley said, in part due to the quarterly nature of Medicaid funding, which relies on hospital and insurance taxes.
“It could be December at the earliest," Kinsley said during a Monday conference call. "It could slip into 2024, but again we need [the legislature's] thumbs up to move forward.”
Kinsley called the delay "tragic" and said some 80% of the people who would get insurance under expansion come from working families. He said 300,000 people, roughly half the expected expansion population, could be added on day 1 because they're already part of a smaller Medicaid program that funds family planning but not full health insurance.
Speaker of the House Tim Moore said in a statement that the General Assembly's priority is "to put together the very best budget for all North Carolinians, and we will continue our work on that this week.”
Spokespeople for Republican Senate leader Phil Berger and House Speaker Tim Moore didn't immediately respond to requests for comment.
Democratic Gov. Roy Cooper’s administration has repeatedly asked the legislature’s Republican majority to decouple Medicaid expansion from the budget process, particularly after the state blew by the July 1 start of a new fiscal year without a new budget in place. Republican leaders, who made expansion contingent on the budget passing when they struck a historic deal in March to expand Medicaid, have declined to do so.
Tying expansion — a top priority for North Carolina Democrats for more than a decade — to the budget gives the Republican majority more leverage over the budget process, forcing Democrats to swallow any number of spending priorities and policy changes if they want to implement expansion, which would pump billions of dollars in federal funding into the state’s healthcare system.
"Each month of delay costs the state hundreds of millions of dollars flowing into communities across North Carolina to support care and treatment for people and help keep providers’ doors open," Kinsley said in a written statement that accompanied Monday's press call.