North Carolina’s Medicaid program wouldn’t shift most of its patients to managed care for another year under a funding measure given tentative approval on Tuesday by the state Senate.

The July 1, 2021, start date is contained in a bill that also locates another $460 million to cover additional expenses during the next fiscal year for Medicaid, the government-run health care plan for mostly poor children, older adults and people with disabilities.

The shift from a traditional fee-for-service program for three-quarters of the state’s 2.2 million Medicaid recipients was to begin late last year and early this year. Four private insurers and a physicians’ partnership awarded contracts by the state would have started receiving fixed monthly payments for every patient seen.

But final funding and details got derailed in a legislative showdown between Republican legislators and Democratic Gov. Roy Cooper. The stalemate also was connected to the governor’s pitch to expand enrollment to cover hundreds of thousands of additional low-income adults. Republicans, particularly in the Senate, oppose the expansion idea.

Tuesday’s measure doesn’t contain expansion. But it puts financial disincentives in place to kick-start managed care. The five managed-care contractors each would receive $4 million for every month in which it doesn’t begin beyond the July 2021 start.

The measure, which needs one more Senate vote before going to the House, also directs the state to select land in Wake County to relocate the current offices of the Department of Health and Human Services on the old Dorothea Dix hospital campus in Raleigh. The 2019 budget bill, which Cooper vetoed and never took effect, had directed the Dix campus move to Granville County.

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