Gov. Cooper Signs Medicaid Expansion Into Law

North Carolina to become 40th state to expand Medicaid, expected to provide health coverage to more than 600,000 North Carolinians.

At the end of March Governor Roy Cooper signed House Bill 76, Access to Healthcare Options, into law. The legislation will expand Medicaid, which is expected to provide health coverage to over 600,000 people across North Carolina and bring billions in federal dollars to the state. North Carolina is the 40th state to expand Medicaid.

“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,” said Governor Cooper. “This is a historic step toward a healthier North Carolina that will bring people the opportunity of better health and a better life.”

According to the NC Department of Health and Human Services, Medicaid expansion, along with the state’s federally funded Healthcare Access and Stabilization Program (HASP), will bring $8 billion annually to North Carolina with no additional cost to the state. Another $1.8 billion will support behavioral health, rural health care, and other needs.

Expanding Medicaid has been a top priority for Governor Cooper since he took office. Since 2017, he has worked within the confines of state law to begin the expansion of Medicaid, even when Republican legislators sued him in federal court to stop the process. Without Medicaid expansion, North Carolina has missed out on an estimated $521 million each month that could go to improving mental health and helping rural hospitals remain open.

Veterans, early childhood educators, restaurant workers, nursing home workers are all among the groups that often fall into the coverage gap and sometimes have to work two or more jobs to afford health care.

In North Carolina, rural residents are 40% more likely to be uninsured and eligible for Medicaid expansion, and eleven rural hospitals have closed since 2005, with more at risk of closure due to a lack of paying customers. North Carolina, like other states, is currently dealing with an opioid and substance abuse crisis. About 40% of overdose patients in emergency departments are uninsured, making it harder for them to get the follow-up mental healthcare coverage they need.

Governor Cooper’s budget, First in Opportunity, proposes using a portion of the almost $1.8 billion Medicaid expansion signing bonus to create the Improving Health Outcomes for People Everywhere (IHOPE) Fund. The plan focuses on three areas: making mental health services more available when and where people need them; building strong systems to support people in crisis and people with complex behavioral needs; and enabling better health access and outcomes with data and technology. Medicaid expansion will take effect upon the signing into law of the FY 2023-25 appropriations act.