Hospital letter may lead to NC Medicaid expansion compromise


House Speaker Tim Moore talks with Sen. Phil Berger as they await the arrival of Gov. Roy Cooper for the State of the State address on Monday, April 26, 2021 in Raleigh, NC

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Medicaid expansion, which would provide health insurance to about 500,000 more North Carolinians, is getting closer to happening.

And it moved even closer on Friday with a proposal from the North Carolina Healthcare Association.

Leaders of both major parties agreed they want to expand eligibility for Medicaid, but have been bogged down this summer over exactly how and when. Now the group that represents hospitals in North Carolina says it is ready to support some changes in the state’s “certificate of need” law if the General Assembly will agree to Medicaid expansion.

Up to now, hospitals have supported Medicaid expansion but opposed any changes to certificate of need, which determines what medical services are available in the state. The law helps reduce competition hospitals might face for lucrative outpatient services that help underwrite other parts of their operations.

The certificate of need law and other changes to health care policy have been at the core of negotiations between the House and Senate about what a Medicaid expansion bill should include.

On Friday, the association sent a letter to Democratic Gov. Roy Cooper, Republican Senate leader Phil Berger and Republican House Speaker Tim Moore say it’s open to changes on certificate of need. NC Tribune/Business NC was first to report the proposal.

“It’s critical that we act right now to pass Medicaid expansion to save lives and secure the $521 million we are losing every single month in federal funding,” Cooper told The News & Observer in a statement Friday night. “This proposal provides a path to agreement and it’s time to get this done,” he said.

Cooper says negotiators are close

Cooper said Tuesday that Medicaid expansion negotiations were “this close” to being done.

“We can turn on the spigot to saving lives,” he told reporters. North Carolina is losing “$521 million every month that goes by, from the federal government,” he added. “That’s unconscionable.”

Explaining what he meant by “this close,” Cooper said that “if there could be an agreement on CON, then we could get an agreement on Medicaid expansion.”

With the NC Healthcare Association’s letter on Friday, it appears even closer.

“In an effort to get stalled negotiations moving, and in response to Senator Berger’s and Governor Cooper’s requirement that Medicaid expansion be coupled with certificate of need reform, our board of trustees has made the difficult decision to propose certificate of need law reforms,” NCHA Board Chair Dr. Roxie Wells, president of Cape Fear Valley Health Hoke Hospital, said in a release.

Details of the offer

The association said it would support changes in the law regarding ambulatory surgical centers and would support repeating certificate of need requirements for inpatient beds for patients with psychiatric problems and chemical dependency.

The association said hospitals collectively could lose $700 million in revenue a year from the proposed changes in certificate of need for outpatient surgical centers. The changes could be particularly hard on small community hospitals, which are more dependent on those services to help cover other costs, Wells said.

Wells said Friday that, “CON law changes could threaten the survival of community hospitals if they are not implemented carefully.”

“We are putting a lot of trust in legislative leaders to do this correctly,” Wells said. “If this policy damages access to local health care services, we hope that government leaders will find the resources to preserve crucial health care services and facilities, including safety-net services that North Carolinians rely on.”

Legislative negotiations

Berger has wanted the Senate version of an expansion bill that includes changes to health care policy. Moore and House Republican leaders have wanted a bill without those changes.

“I would prefer to let’s just go ahead and pass it just like it is,” Cooper told reporters on Tuesday. “But Sen. Berger has said that in order for him to support Medicaid expansion there has to be some other medical reforms. Those reforms have merit. They should be discussed.”

He added: “I don’t think it is unreasonable for the hospitals to step up and negotiate with (Berger) on that issue.”

Cooper said this week that in order to find a solution to the expansion impasse between the legislative chambers, he thought there should be “some settlement on the CON issue so that we can have an agreement that can go both through the House and Senate.”

The General Assembly is returning for an expected no-vote session Tuesday. That could change now.

Cooper said without a compromise soon, the state could lose access to this year’s expansion money and some of next year’s federal funds.

“You know how it is with a new legislature, and how long it takes to get organized, and the political landscape may be different,” he said. “So you begin to worry whether you’re going to lose all of the first quarter 2023 Medicaid coverage payments. So I think all of that right now is at risk, and why everybody needs to step up our game and get this done.”

Neal Inman, Moore’s chief of staff, told The News & Observer on Friday evening that they “are still reviewing the proposal.”

Staff writer Richard Stradling contributed to this report.

For more North Carolina government and politics news, listen to the Under the Dome politics podcast from The News & Observer and the NC Insider. You can find it at or wherever you get your podcasts.

This story was originally published September 16, 2022 7:16 PM.

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Profile Image of Dawn Baumgartner Vaughan

Dawn Baumgartner Vaughan covers North Carolina state government and politics at The News & Observer. She previously covered Durham, and has received the McClatchy President’s Award, NC Open Government Coalition Sunshine Award and several North Carolina Press Association awards, including for politics and investigative reporting.


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