Both chambers of the N.C. General Assembly expect this week to take up legislation fully funding the state's Medicaid program for the remainder of this fiscal year.
The bill will send $319 million to Medicaid, funding that Democratic Gov. Josh Stein and N.C. Department of Health and Human Services Secretary Dev Sangvai have been asking for since last summer.
Earlier this month, Sangvai told a legislative committee that North Carolina's Medicaid program would run out of money in May if the General Assembly failed to act. The so-called rebase affects about 2.4 million North Carolinians who receive their health insurance through the state's traditional Medicaid program.
Legislative leaders also signaled Tuesday that the bill — which had not been made public as of 4:30 p.m. — would come with some reforms to the state's Medicaid program.
"Some of the other provisions in the bill really relate to make sure we’re cutting out waste, fraud and abuse, ramping up a bit on the renewal procedures to make sure that folks who are being renewed actually continue to meet the program’s requirements, that we’re not just making the goal to put as many people as possible on Medicaid," Speaker of the House Destin Hall, R-Caldwell, told reporters.
Hall also said there is a provision requiring State Auditor Dave Boliek, a Republican, to audit the Medicaid program.
The goal, Hall said, is to help gain control over soaring costs.
Last year, for instance, DHHS asked the General Assembly for $700 million as part of its rebase package. But Medicaid spending was significantly higher than anticipated, and the department soon returned with an $819 million request.
The General Assembly provided $500 million last summer, leading to the months-long stalemate over the remaining $319 million.
Next year, DHHS is expecting the rebase request to top $1.04 billion, according to Gov. Josh Stein's budget proposal that was released Tuesday.
"It's just not sustainable. At the end of the day, if it continues on, the debates about all these other issues we're talking about are not going to matter because Medicaid is going to swamp it all out," Hall said.
With the additional rebase funds, North Carolina's Medicaid spending will rise above $6.7 billion for the current fiscal year.
Senate Leader Phil Berger, R-Rockingham, agreed with Hall, saying the provisions will "hopefully begin the process of trying to put some sort of constraints on how quickly Medicaid is growing."
Currently, Medicaid provides healthcare coverage for about one in four North Carolinians, two out of every five children in the state and five of every eight people in nursing facilities, DHHS officials told a legislative committee in March.
DHHS officials also said at that meeting that the non-expansion Medicaid population peaked in early 2023-24 and is projected to continue declining for the near-future.
The rebase helps fund healthcare for about 2.4 million North Carolinians who receive health insurance via Medicaid. The state provides initial funding for Medicaid, but that number shifts based on inflation, the program's enrollment and how the insurance plans are actually used.
North Carolina uses the rebase to make up the difference between the initial funding amount and the Medicaid program's actual spending.
The only people who receive Medicaid coverage who are not covered by the rebase are those receiving coverage through Medicaid expansion. Those people's insurance is 90 percent funded by the federal government, with the remaining 10 percent coming from a tax levied on the state's hospital system.
