(The Center Square) – North Carolina’s first budget since the overturn of Roe v. Wade will trigger Medicaid expansion and a $1.6 billion federal bonus that comes with it lawmakers spent on improving the state’s health care system.
The General Assembly gave final approval on Friday to a $60.7 million two-year budget plan. Gov. Roy Cooper, who has pushed for expansion since taking office in 2017, said in a statement on Friday he will allow House Bill 259 to become law without his signature, despite his objections to many Republican spending and policy provisions in the bill.
Sen. Jim Burgin, R-Harnett, described the budget as “the largest investment in health care in North Carolina history,” pointing to a $7.33 billion appropriation in the first year that swells to $7.76 billion in the second. The first year allocation is $829.2 million more than the base budget, he said.
All Republicans voting in both chambers were “ayes” along with five Democrats in the House of Representatives. Those were Reps. Cecil Brockman of Guilford County, Carla Cunningham of Mecklenburg County, Garland Pierce of Scotland County, Michael Wray of Northampton County and Shelly Willingham of Edgecombe County.
Once enacted, roughly 600,000 North Carolinians will be eligible for expanded Medicaid, a move Republicans have resisted since it became available through the Affordable Care Act in 2010. The move is funded 90% from the federal government, and 10% from increased hospital assessments, which are offset by higher reimbursements through a Healthcare Access and Stabilization program.
Medicaid expansion follows legislation enacted by the General Assembly over Cooper’s veto that restricts abortions in North Carolina to the first 12 weeks of pregnancy, with several exceptions.
“One of the longest debates for Medicaid expansion will finally come to an end,” Sen. Ralph Hise, R-Mitchell, said as he presented the budget on Thursday, explaining how the state will spend a $1.6 billion incentive to expand the government health insurance program.
The spending includes $319 million for the construction of a new UNC children’s health hospital; $55 million for community college health care programs and $40 million for other health care workforce programs; $40 million in employee bonuses for state health facilities; $60 million for direct care workers; and $130 million in increased reimbursement rates for mental health and substance use service providers.
Other spending includes $6.25 million of new funding each year of the plan for grants to crisis pregnancy centers, a provision that Sen. Natasha Marcus, D-Mecklenburg, described as irresponsible.
Marcus called out many of the participating organizations she said list addresses at residences, empty fields, a highway median, and other questionable locations. The Center Square did not confirm her allegations.
“This budget gives over $20 million of taxpayer money to organizations that exist for the purpose of dissuading, misinforming and pressuring pregnant people,” she said. “These organizations … commonly referred to as crisis pregnancy centers are not medical clinics. They are not honest advisors of a person’s options or the risks and costs associated with continuing a pregnancy versus terminating one.”
Planned Parenthood South Atlantic, which is challenging the state’s abortion law in court, echoed Marcus’ concerns about the crisis pregnancy centers.
“In the same year that state lawmakers severely restricted access to abortion, they are giving more than $20 million in taxpayer funds to anti-abortion, anti-LGBTQ organizations that lie to pregnant people seeking abortion care and only exist to dissuade someone from having an abortion,” read a statement on Friday. “This is by far the most money ever given to these sham organizations that are generally unregulated, unlicensed, and target people experiencing financial hardship.”
Other Democrats including Sen. Natalie Murdock of Durham County argued the budget underfunds the state’s existing Medicaid programs.
“A hundred and eight million is underfunded regarding what is currently needed for Medicaid and around $8 million for Medicaid transformation, and this underfunding is not due to Medicaid expansion,” she said Thursday.
That will “negatively impact things that everyone in this chamber cares about, including mental health reform, and providing better Medicaid services for children in foster care,” she said.
The budget contains a wide array of mental health policies and spending. One provision will give the state Department of Health and Human Services more control over local mental health agencies to strengthen the system, while another will allow those using the services to switch providers, which is not currently an option.
The budget includes $80 million for services to help families with children suffering from mental health issues, $170 million in rate increases for nursing homes, and $210 million for UNC and ECU to create three clinics in rural areas.
The North Carolina Health Association thanked lawmakers for including Medicaid expansion with the budget and highlighted the benefits in a statement Friday.
“Medicaid coverage will allow 600,000 working North Carolinians access to regular, preventative care, reducing emergency department visits, and providing much needed help for those who struggle with addiction and behavioral health issues,” the statement read. “Medicaid expansion will save lives, improve health, help with retention of health care providers, and provide needed financial support to struggling rural hospitals.”
The American Cancer Society’s Cancer Action Network also heralded North Carolina’s coming Medicaid expansion, $1 billion in additional funds to make it happen, $43.5 million for cancer research and $1.6 million for the state’s Breast and Cervical Cancer Control Program included in the budget.
“We’re thrilled to see the Legislature take the final step to provide lifesaving coverage and care for 600,000 North Carolinians by funding the program and ensuring it stands to benefit future generations,” president Lisa Lacasse said in a statement.
The action network, however, took issue with provisions in the budget that lower taxes on some tobacco products, and a ban on government vaccine requirements.