N. Carolina Hospitals Offer New Medicaid Expansion Proposal

Written by GARY D. ROBERTSON

North Carolina’s hospitals and hospital systems on Friday unveiled an offer that could shake up stalled negotiations to pass legislation that would expand Medicaid to cover hundreds of thousands of low-income adults in the state.

The North Carolina Healthcare Association said the offer sent to Republican legislative leaders and Democratic Gov. Roy Cooper also contained reforms to some state laws that require regulatory approval before certain medical buildings can be constructed or services offered in a region.

Senate leader Phil Berger this summer accused the association of refusing to compromise on “certificate of need” rules. Changes to these rules were contained in the Senate version of an expansion measure approved in June. Berger said they were needed to increase the supply of medical services that would be needed to treat the growing Medicaid population.

Cooper, a big expansion proponent, told reporters earlier this week that it would make sense for hospitals to negotiate with Berger on those rules, which hospitals contend help community facilities that disproportionately serve the uninsured or underinsured remain open.

“Our board of trustees has made the difficult decision to propose certificate of need law reforms,” board chair Dr. Roxie Wells said in a news release. “CON law changes could threaten the survival of community hospitals if they are not implemented carefully. We are putting a lot of trust in legislative leaders to do this correctly.”

The House passed its own expansion bill during the final week of the General Assembly’s primary work session this year that contained none of the medical supply-side proposals that the Senate wanted. House Speaker Tim Moore has said Republicans in his chamber would prefer to handle those provisions separately from expansion.

Moore’s office was still reviewing the offer late Friday, Chief of Staff Neal Inman said. Berger spokesperson Lauren Horsch said the same thing, adding: “We appreciate the NCHA’s willingness to come to the table with a proposal.” There was no immediate response late Friday from Cooper’s office.

The General Assembly is scheduled to reconvene Tuesday for what’s expected to be a three-day administrative session with no recorded floor votes. They are next scheduled to return to Raleigh in October.

North Carolina is one of a dozen states that have yet to accept the federal government’s offer to cover people who make too much to be insured by traditional Medicaid but too little to receive subsidized private insurance. The federal government would pay 90% of the medical costs of expansion.

The association said its proposal would have hospitals paying a majority of the state’s share to cover another 600,000 people at a cost of over $550 million annually. The state’s hospitals also would participate in a federally funded program that would enhance their Medicaid reimbursement rates for providing care, providing new revenues.

The proposal would do away with certificate of need laws for psychiatric inpatient beds and beds to treat people with chemical dependency. It also, within five years, would scale back regulations for operating rooms within ambulatory surgical centers, which the association says would result in a loss of revenue for them.

“Each day the General Assembly waits is a day that harms 600,000 North Carolinians,” association president and CEO Steve Lawler said. “We hope that any legislation crafted will be done in a thoughtful way that protects health care facilities that take care of people and improve community health.”

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