By Gary D. Robertson
Associated Press

RALEIGH — North Carolina Senate Republicans are strongly considering legislation that would expand Medicaid coverage to hundreds of thousands of additional low-income adults. Such legislation would mark a key step in an extraordinary turnabout by GOP members in the chamber set against expansion for a decade.

A draft bill yet to be formally filed also would include several other medical, health care coverage and insurance reforms, according to a summary of the bill obtained by The Associated Press. Many of these proposals, including expansion, have been discussed in a House-Senate health care study committee that’s met several times since February.

“Senate Republicans continue to have discussions about how to address the rising costs of health care and how to increase access in the state,” Lauren Horsch, a spokesperson for Senate leader Phil Berger, said Monday. Horsch confirmed the summary’s authenticity but could not say if and when legislation would be filed during the General Assembly’s annual work session, which began last week and likely will end around July 1.

The measure’s showpiece would be Medicaid expansion, which Republicans were cool to or outright against for several years after the 2010 federal Affordable Care Act authorized the coverage for people earning too much money for traditional Medicaid coverage. North Carolina is one of a dozen states that have not expanded Medicaid.

But Berger said last fall he was now open to expansion, in part because he was now convinced the federal government’s 90% share of expenses for expansion enrollees would not soon be eliminated. More Republicans also are intrigued by the idea because the 2021 federal COVID-19 relief law would give North Carolina $1.5 billion over two years to treat traditional Medicaid patients if it accepts expansion.

Horsch said Berger has seen the omnibus proposal described in the summary but declined to say whether he supports it.

The bill summary says the expansion proposal, called “NC Health Works,” would cover adults with income of up to 138% of federal poverty guidelines, likely covering at least 600,000 people. Right now, about 2.7 million North Carolina residents are enrolled in Medicaid. Some current enrollees who have remained on the rolls during the pandemic would ultimately be covered by expansion.

The summary says the state’s 10% share of expansion expenses would be paid through a new assessment on hospitals. Expansion would end if Congress increased the state’s share. The program also would include a work requirement for expansion recipients — a mandate that in other states has been struck down by federal courts and blocked elsewhere by President Joe Biden’s administration.

It’s unclear whether the absence of a work mandate would be a deal-breaker for House Republicans, which had pushed an expansion bill in 2019 containing such a requirement.

House Speaker Tim Moore said last year that at the time, he did not see support within the House Republican Caucus for expansion.

Talking to reporters last week, Moore said he “would be surprised” if a Medicaid expansion agreement could be reached with the Senate before the work session ended. A House co-chairman of the health care study committee has said he did not expect any action on panel recommendations until the fall, so a Senate proposal would certainty attempt to accelerate the process.

Any bill would have to pass both chambers before heading to Democratic Gov. Roy Cooper, who has sought expansion repeatedly since taking office in early 2017. His budget-adjustment proposal released earlier this month contains it again.

“I believe that we’re getting closer than ever to an agreement,” Cooper said May 11. “I do appreciate that Republican leaders are taking this seriously.” A 2019 budget stalemate between the governor and GOP leaders centered around expansion.

According to the summary, first reported by Axios, the bill also would streamline and narrow “certificate of need” laws that require health regulators to sign off on expansion plans by hospitals and other medical providers before moving forward.

The measure also would permit nurse practitioners, certified nurse midwives and nurses with other advanced specialties to practice without a physician’s formal supervision. The legislation also would require health insurers in the state to cover telehealth services, and in-network health facilities would have to alert consumers when out-of-network providers are scheduled to provide care.