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North Carolina is the latest state poised to expand its Medicaid program, joining 40 others (including Washington, DC) that have embraced the Affordable Care Act (ACA) policy. The decision comes after years of debate and pushback in Raleigh, the state’s capital.
State lawmakers voted Thursday to give final approval to a bill that will expand Medicaid coverage to adults under 65 with annual salaries at or below 133% of the federal poverty level (which is $19,391 for individuals or $33,064 for a family of three at the time of writing). The expansion will add an estimated 600,000 North Carolinians to the state’s Medicaid rolls, according to the state Department of Health and Human Services. About 3 million North Carolinians are enrolled in Medicaid.
Gov. Roy Cooper said in a Thursday statement that he looked “forward to signing this legislation soon.” He called Medicaid expansion “a once-in-a-generation investment that will make all North Carolina families healthier while strengthening our economy.”
The bill, however, will not take effect until the state budget is approved, which is likely to happen later this year.
North Carolina’s Medicaid expansion push comes just months after voters in South Dakota, another Republican-led state, approved a November referendum to expand that state’s Medicaid program—and 13 years after former President Barack Obama signed the ACA into law.
Medicaid expansion advocates in Alabama, meanwhile, urged GOP leaders this week to embrace the policy and the federal funding that goes along with it.
The American Rescue Plan Act, a Covid-19 relief package that Congress passed in 2021, contained financial incentives to encourage states to adopt a Medicaid expansion. That includes a 5 percentage point increase to a state’s regular federal matching rate for two years after expansion takes effect (in addition to the 90% federal matching funds for adults available under the ACA for the new expansion population).
North Carolina lawmakers initially rejected Medicaid expansion in 2013. But opposition to the Obama-era policy has waned in recent years, with some major critics like Senate leader Phil Berger publicly changing their stances, according to the Associated Press.