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North Carolina Medicaid expansion hits Certificate of Need snag

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For years, Medicaid expansion has been a contentious issue in North Carolina. Democratic Gov. Roy Cooper has supported the measure, while Republican legislative leaders have opposed it.

There’s been a shift recently, though: Republican leaders now support expansion and a holdup on the measure centers on disagreements over the state’s Certificate of Need law.

Expanding Medicaid would provide health coverage to at least half a million additional residents, according to the state’s Department of Health and Human Services. North Carolina is among roughly a dozen U.S. states that have not expanded Medicaid.

Currently, to be eligible for Medicaid, North Carolinians must be below a certain income level. For example, a family of four must earn less than roughly $37,000 a year. They also must be: pregnant, 65 or older, responsible for a child, blind, have a disability or care for someone with a disability. If Medicaid were expanded, people could qualify for Medicaid based only on their income.

Many Republicans in North Carolina’s statehouse, including Senate Leader Phil Berger and House Speaker Tim Moore, were historically opposed to Medicaid expansion. They were primarily worried about the cost — especially about whether North Carolina would be able to fund the expanded program if the federal government stopped funding 90% of it.

But in May, Berger and other Senate Republicans announced they would support Medicaid expansion.

“My view on this has changed,” Berger told reporters at the time during a news conference.

He added, jokingly: “If there’s a person in the state of North Carolina that has spoken against Medicaid expansion more than I have, I’d like to meet that person.”

The state Senate and House this summer each passed separate bills on Medicaid expansion but negotiations hit a snag over part of the Senate proposal that would roll back rules on adding new hospital services. Under the state’s Certificate of Need law, or CON law, if hospitals want to add things like an operating room or more beds, they are currently required to ask permission from the state health department.

The CON law is intended to cut down on competition. Hospital systems say it prevents outside hospital systems from setting up in the state and saturating the market. They also say the law contains prices for patients and reduces duplicative services.

The House, along with the North Carolina Healthcare Association, which represents 135 hospitals, initially said they did not want any changes to the CON law. Then, last week, the NCHA sent Cooper, Berger and Moore a proposed compromise. They suggested a handful of changes to the CON law, including removing the need for state approval for new psychiatric beds and some outpatient surgery operating rooms. Berger slammed this proposal Monday, telling reporters in Raleigh the association’s proposal was “not even close” to meeting his expectations. Berger told reporters he didn’t want to “negotiate through the press.”

Moore had not spoken publicly in response to the NCHA’s proposed compromise as of Thursday afternoon.

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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.