In late July, the N.C. Department of Health and Human Services announced its plan to move forward with an expansion of Medicaid starting Oct. 1. 

As budget talks linger, however, that start date could hinge on whether lawmakers can come to a spending plan by Sept. 1 or fund the expansion separately if a state budget doesn’t pass soon.

The Medicaid expansion includes a signing bonus of $1.8 billion from the federal government in addition to $521 million per month to North Carolina that would boost rural hospitals by increasing reimbursement rates and reducing the risk of financial troubles. 

The expansion – once implemented – is expected to provide coverage to an estimated 600,000 low-income residents in the state who did not previously qualify for Medicaid.

“We are pleased that North Carolina became the 40th state to make patient access to care a priority by expanding Medicaid,” a Novant Health New Hanover Regional Medical Center spokesperson said. “This initiative has been more than a decade in the making and will allow more than 600,000 patients to gain health insurance coverage – and the preventive and other care it enables. We know that when people gain access to health insurance, they are more likely to obtain an early diagnosis and treatment, which contribute to improved health outcomes.”

Gov. Roy Cooper signed the bill authorizing Medicaid expansion into law on March 27. 

“Medicaid expansion is a once-in-a-generation investment that will strengthen our mental health system, boost our rural hospitals, support working families and so much more,” Cooper said at the time.

In late August, Cooper held a roundtable discussion in rural Yadkin County to highlight the need to start Medicaid expansion, which this year received bipartisan support during the legislative vote on the measure. 

While the March announcement allowed the N.C. Department of Health and Human Services (NCDHHS) to move forward with the required public notices for beneficiaries, a provision that the governor opposed in the bill tied enactment of the expansion to passage of this year’s state budget. 

Legislative leaders said then that a budget would be passed by June. Despite holding supermajorities in both chambers, the legislature still has not passed a budget putting counties and providers in a wait state. 

If NCDHHS does not have authority from the General Assembly to move forward by Sept. 1, the earliest fallback date is Dec. 1, and depending on how late authority is given, it could fall into 2024. 

If given final authority from the legislature by Sept. 1, Medicaid expansion in North Carolina would increase the eligible population to adults aged 19-64 who have incomes up to 138% of the federal poverty level on Oct. 1.

“We continue to monitor the legislative budget process and CMS approvals to understand when Medicaid expansion may go into effect in North Carolina,” Novant NHRMC officials said. “As Medicaid expansion is finalized, Novant Health’s first priority will be to communicate with patients and community members to help them navigate their options and direct them to the right resource. This includes coordinating with community partners to ensure eligible individuals have the opportunity to enroll and establish care with a provider, as well as staying in close connection with managed Medicaid partners. 

“Novant Health also has a longstanding practice of screening uninsured patients for Medicaid eligibility during their hospital visits.”