A Democratic-sponsored bill would expand the state's Medicaid program in part through funding from an assessment of the state's hospitals.
It is a similar strategy to what has been proposed in House Bill 662 by four House Republicans, including Rep. Donny Lambeth, R-Forsyth. It represents the third Democratic attempt at expansion.
Expansion supporters, as well as several academic studies, have determined that expanding Medicaid could benefit more than 500,000 North Carolinians - potentially raising total Medicaid recipients to 2.4 million.
House Bill 858, filed Wednesday, would establish a Medicaid expansion assessment that would pass through the General Fund. Primary sponsors are Reps. Jean Farmer-Butterfield, D-Wilson, John Autry and Beverly Earle, both D-Mecklenburg, and Bobbie Richardson, D-Franklin.
The bill also would repeal the state law passed in 2013 by the Republican-controlled legislature that forbids the governor from pursuing Medicaid expansion without legislative approval.
Analysts say that condition is likely to draw criticism from Republican legislative leaders who have fought in federal court since January to halt Democratic Gov. Roy Cooper's Medicaid expansion waiver request with federal health officials.
"Overall, I believe this bill further highlights growing support for expansion," said Ciara Zachary, a policy analyst with the left-leaning N.C. Health Advocacy Project.
The assessment in HB858 would be calculated by the state Health secretary. It would encompass "the total state share of service and administrative costs of Medicaid expansion for the applicable time period, the hospital's share of all Medicaid services billed, and the amount assessed to the hospital."
The Medicaid assessment would take priority over any other assessment hospitals pay.
HB858 lists state funds of $27.5 million for fiscal 2017-18 and $41 million for fiscal 2018-19 for administrative costs. That assessment would nearly match projected federal funding of $29.1 million for fiscal 2017-18 and just under $43 million for fiscal 2018-19.
There would be a state appropriation for Medicaid services costs, representing $114.8 million for the first half of 2017-18. Another $6.7 million would be provided from the N.C. Division of Mental Health, Developmental Disabilities and Substance Abuse.
Those funds would serve as a state-required match of $1.245 billion in federal funding for 2017-18.
For 2018-19, the state would provide $273.4 million from the General Fund, $13.5 million from MHDDSA funding and $7.88 million from the N.C. Division of Adult Correction's inmate health-care program. The projected federal funding would be $3.47 billion.
In both instances, if more federal funds are provided than projected, the state funding would be reduced by the federal overage.
By comparison, HB662, titled "Carolina Cares," requires "participant contributions."
Lambeth said the expansion initiative would work "more like an insurance product for those working who can pay a portion of the cost, and the benefits and coverage are built around preventive and wellness care."
For example, participants must follow protocols for routine physicals and screenings to improve their health if they have conditions such as diabetes, overweight, etc."
The bill represents the first bona fide expansion attempt by Republican legislators even though many in the party seem to oppose any initiative.
Participant contribution would consist of an annual premium, billed monthly, representing 2 percent of their household income. That element appears to be based on the Healthy Indiana Medicaid expansion plan established by former Gov. Mike Pence.
Participants must be employed or pursuing a job to qualify, a component that may draw criticism from some expansion supporters.
The bill includes several qualifying exemptions: individuals caring for a dependent minor child, adult disabled child or disabled parent; in active treatment for substance abuse; and determined to be medically frail.
"I am meeting with groups to inform them of the benefits and value," Lambeth said Thursday.
The N.C. Medical Society and N.C. Hospital Association have signaled their support for Cooper's proposal that would include not-for-profit health care systems helping to pay the state's 5 percent match of Medicaid expansion administrative costs for 2017, 2018 and 2019.
The association said it is reviewing HB662. It could not be reached for comment about HB858.
"We appreciate Rep. Lambeth and his House colleagues for seeking an innovative solution to this critical issue and stand ready to work with the General Assembly and the Cooper administration to address the financial aspects of the plan," NCHA spokesman Julie Henry said.
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