North Carolina deal on Medicaid expansion

[seeyalater52]

We don’t have a ton of good news to share in the health policy world these days so I thought this would be fun: this morning legislators in North Carolina shared that they’d reached an agreement between state House and Senate leaders on a path forward for expanding Medicaid in the state.

It took them a year of arguing about provisions of the bill that didn’t have to do with Medicaid expansion, and of course the 7 or so years we worked on it prior to this announcement, but I’m so happy that our work has paid off and we can cross another state off the list. This is the first legislative passage of a new Medicaid expansion since Virginia in 2018, and with 600,000+ people standing to gain coverage it is a HUGE win for expanding health coverage to low income people. The last few states to expand (via ballot) had many orders of magnitude fewer people eligible so we are looking at taking an enormous chunk out of the total people stuck in the Medicaid coverage gap nationally.

The bill will pass later this session and should go into effect in 2024.

thehill.com/homenews/state-watch/3881065-north-carolina-republicans-reach-deal-to-expand-medicaid/

We are having a pretty bad leg session year so it’s nice to have a big win like this and feel like all our work is actually making a difference. 10 more states left to expand. Let’s do it!

[Deleted]

Every now and then a blind squirrel finds a nut! But seriously, thanks for the good news, and thanks for your hard work!

[seeyalater52]

Mar 2, 2023 20:39:13 GMT -5 @villainv said:

Every now and then a blind squirrel finds a nut! But seriously, thanks for the good news, and thanks for your hard work!

I’m laughing so hard trying to figure out if I’m the blind squirrel or the nut in this scenario 😂😂

Thank you. It is hard work and soul sucking but it’s awesome to win. Hopefully these are not the last Republicans on earth who love free money more than they hate poor people!

[Deleted]

Mar 2, 2023 20:48:03 GMT -5 seeyalater52 said:

Mar 2, 2023 20:39:13 GMT -5 @villainv said:

Every now and then a blind squirrel finds a nut! But seriously, thanks for the good news, and thanks for your hard work!

I’m laughing so hard trying to figure out if I’m the blind squirrel or the nut in this scenario 😂😂

Thank you. It is hard work and soul sucking but it’s awesome to win. Hopefully these are not the last Republicans on earth who love free money more than they hate poor people!

“Even shitty politicians/corrupt systems sometimes end up doing the right thing”, at least it this context.

[sexycarrot]

Chiming in as someone in North Carolina who works in mental health--this is great news!!

Deep gratitude to you and all those who worked for this.

[mrsd2006]

You think it will ever expand in GA?

[seeyalater52]

Mar 3, 2023 10:20:58 GMT -5 mrsd2006 said:

You think it will ever expand in GA?

Yes. We are working so hard. As you may have gathered if you live in GA it’s all been complicated by Kemp’s idiotic “pathways” plan, which is a terribly expensive and ridiculous partial expansion that will cost more than full Medicaid expansion but cover far fewer people (and eligibility will drop from baseline bc a judge allowed them to go forward with the work requirement.) So it’s messy, but we will never stop trying in GA or any of the other remaining states unless some new alternative to Medicaid expansion or opportunity for federal action shifts the landscape to allow for another method to get people in the Medicaid gap insured.

That said, I think AL might be the next state up.

[sent]

Is there a plan to get providers and hospital systems to accept Medicaid? Typically Medicaid has reimbursed less than Medicare and private plans.

[seeyalater52]

Mar 3, 2023 12:25:20 GMT -5 sent said:

Is there a plan to get providers and hospital systems to accept Medicaid? Typically Medicaid has reimbursed less than Medicare and private plans.

Individual states set their own Medicaid reimbursement rates with guidelines from the federal government. They’re often lower but it depends on the state. You’re likely coming at this from the perspective of someone practicing in a state that has had Medicaid expansion - these southern states that haven’t had Medicaid access for adults for all of these years have hundreds of thousands of people who are uninsured and have absolutely no access to health care except emergency care or what a stretched system can provide through free/sliding scale health clinics. Having Medicaid reimbursement rather than taking a complete loss for uncompensated care is a huge game changer for hospitals and health centers. We have not seen any extreme challenges in other states that have expanded in terms of lack of providers to meet increased need or people being unable to find providers that accept their coverage. Those issues exist at baseline to a certain extent in most states (some more than others) in both private insurance and in Medicaid but are not really driven by the decision to expand or not expand Medicaid, which is primarily about coverage access.

There will always be work to be done to continue to improve Medicaid - reimbursement rates, scope of covered services, provider access, usability, barriers to continuous coverage/renewal etc. but this is the baseline that allows that other work to happen and is literally lifesaving for tens of thousands of people. Also it’s not my job to fix the entire system, although my team does often consult with others working on these adjacent policy areas.

[sent]

seeyalater52 , thanks for the explanation.

I do remember hearing that there were states that turned down the money from the Federal Government to expand access to care whether it was through the ACA or Medicaid expansion (can't recall which one). And I felt bad for the people of those states that their leaders would do that. So nice work on this.

Yes, our state has had Medicaid in place for adults for many years. Everyone in private practice cites that the reimbursement is abysmal. Some of the plans are difficult to deal with as a provider. I know from personal experience that care is a huge two tier system in private practice but not so much difference in treatment as an in-patient in the hospitals. However it takes a very long time to get seen in the hospital system for non-emergent things that can be treated in their outpatient clinics.

[seeyalater52]

Mar 3, 2023 14:08:52 GMT -5 sent said:

seeyalater52 , thanks for the explanation.

I do remember hearing that there were states that turned down the money from the Federal Government to expand access to care whether it was through the ACA or Medicaid expansion (can't recall which one). And I felt bad for the people of those states that their leaders would do that. So nice work on this.

You’re exactly right - Medicaid expansion was supposed to happen in all states under the ACA but before that was implemented the Supreme Court made it optional for states to choose to take the money and expand (at the time it was free for states, then over time the state share was increased and will remain at a baseline of 10%, but the program pays for itself in many ways if you account for all the costs of un/underinsured people.

I’m not here to pretend it is a magic bullet that solves everything, but for low income people even being able to access an any kind of doctor or medical care at all can be a game changer. Even if the system isn’t perfect, and even if there are gaps in that care that still need to be addressed.

[seeyalater52]

We did it! Cooper signs today.

[Poeticxpassion]

seeyalater52, thank you for your hard work on Medicaid expansion. It has been a huge lifesaver to me personally.

[lilac05]

I love when you get to share good news in this area. Not only because it means great things for whoever is impacted, but because I know you work so hard and hit so many roadblocks. Thank you for all that you do to help get Americans the services that they need.