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What's Next For Medicaid In North Carolina?

Kaiser Family Foundation
North Carolina is one of a handful of states not to have adopted Medicaid expansion.


North Carolina is still without a full state budget after state senators did not hold an expected vote to override Gov. Roy Cooper’s veto Tuesday. That means planned changes to how Medicaid pays healthcare providers are up in the air. 

Medicaid is the health insurance program for low-income adults, children, pregnant women, the elderly and people with disabilities.

North Carolina was scheduled to massively change the way it administers its Medicaid program starting Feb. 1. It would move from a model called fee-for-service to one called managed care. Under the new model, the state would pay a fee to a managed care plan, which would in turn pay doctors who provide services. The state currently pays doctors directly.

NC Medicaid Deputy Secretary Dave Richard said the transformation plan is now on indefinite hold.

"Without a budget, we don't have access to the funds that we need and some of the technical changes that are important to go live with managed care," Richard said.

Nearly 2.2 million residents are enrolled in Medicaid in North Carolina, according to state data, including 202,000 in Mecklenburg County.

"If people are worried about if this delay does something to their eligibility or some other part of their program, the program that exists today continues until we make that transformation," Richard said. 

It is unclear when lawmakers will revisit the budget issue.

North Carolina is also one of 14 states that has not expanded Medicaid under the Affordable Care Act. Expansion would make the health insurance program available to around 389,000 additional North Carolina residents, according to the Kaiser Family Foundation.

In June, Democratic Gov. Roy Cooper vetoed the state budget proposed by the Republican-controlled legislature largely over the issue of Medicaid expansion. 

"Hundreds of thousands of North Carolinians working hard for a living can't afford healthcare," Cooper said at a press conference. "Their paycheck is too high for Medicaid, but not enough to pay for a private insurance policy."

But Republicans said they are worried about the cost. Republican Senate leader Phil Berger wrote in an op-ed in June that although the federal government currently pays 90% of the annual cost of Medicaid expansion, he is worried about what could happen if the federal government starts paying less. Berger noted the federal government changed its match rate for the Children’s Health Insurance Program, which he said left the state with a budget hole.


The federal government reduced its match rate for CHIP for this fiscal year by 11.5%.


North Carolina lawmakers are expected to return to Raleigh on April 28.


Claire Donnelly is WFAE's health reporter. She previously worked at NPR member station KGOU in Oklahoma and also interned at WBEZ in Chicago and WAMU in Washington, D.C. She holds a master's degree in journalism from Northwestern University and attended college at the University of Virginia, where she majored in Comparative Literature and Spanish. Claire is originally from Richmond, Virginia. Reach her at cdonnelly@wfae.org or on Twitter @donnellyclairee.