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Medicaid expansion set for a vote, as Cooper tees up a $1 billion mental health plan

News & Observer - 3/9/2023

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Luciana Perez Uribe Guinassi here. It’s been an eventful past few weeks.

This is my first time covering a legislative session, so when it kicked off earlier this year, I wasn’t sure what to expect. In particular, as a politics reporter with a focus on health, I was interested in how Medicaid expansion negotiations would play out.

Considering the backdrop of previous failed negotiations, I was dubious of a deal, despite hearing whispers of compromise between the House and the Senate.

So I was not expecting House Speaker Tim Mooreand Senate leader Phil Berger to announce last week that they had reached a deal on Medicaid expansion, which would provide insurance coverage to 600,000 or so low-income North Carolinians.

This week, the Senate filed the compromise version of the Medicaid expansion bill, building on the House’s version passed in February. House Bill 76 has zoomed through committees and Berger said Thursday he expects it to head to the Senate floor for votes Tuesday and Wednesday. I asked him whether he expected any opposition. He said they were “still working on it.”

One legislator now in opposition is Moore County Republican Rep. Ben Moss.He originally voted in favor of HB 76, which passed by wide margins, but on Thursday he wrote in a statement he will vote against the bill when it comes back to the House for further consideration.

“Medicaid expansion is a budget black hole that would crowd out important spending,” Moss said in a news release. “The heavy hand of government is not able to supplant the free market approach to keeping healthcare affordable for all.”

He urged colleagues to join him in supporting the SAVE ACT — which grants high-level nurses more autonomy – and a full repeal of Certificate of Need regulations, which determine what medical services are available across the state. These provisions largely were the cause of the impasse last session.

The compromise expansion bill includes some certificate of need cuts and does not include the SAVE Act. It also includes many other provisions, which you can read more about in our coverage.

On to other health updates

Gov. RoyCooperreleased a plan Wednesday that lays out how to invest $1 billion to address the state’s mental health and substance use crises.

Cooper’s budget proposal, which will come out in the coming days, will lay out the funding for this plan, which takes into account expanding Medicaid, according to a spokesperson.

These are some of the key spending items in the proposal:

$225 million to raise Medicaid reimbursement rates

$200 million for housing support, mobile crisis teams and improving drop-in clinic services

$175 million to improve behavioral health and physical health services provided in communities and schools

$150 million for behavioral health and justice systems

Read the full plan here.

If you want to read more about the substance use crisis in the state, be sure to read a story by Ames Alexander,Teddy Rosenbluth and me dropping Friday morning on how Medicaid expansion may help those wrestling with addiction.

Now back to the budget:

The same day Cooper released his behavioral health strategy, Republican lawmakers reached an agreement on how much money the state budget will spend: for the first year of the two-year plan, spending will increase by 6.5%,and in the second year, 2024-25, it’ll grow by 3.75%.

Dawn Baumgartner Vaughantells us Berger’s office confirmed that means spending will be about $29.7 billion in 2023-24 and about $30.8 the following year. The 2023-24 fiscal year begins July 1.

More from the team

And while expansion and the budget are plenty to keep us entertained, many other interesting developments went down Under the Dome this week:

A pair of Republican legislators filed a bill ordering a Union County charter school’s approval after the State Board of Education rejected its application. Be sure to read Anna Maria Della Costaand Keung Hui’s story.

Thanks for reading. See you next week. In the meantime, tune into our stories, our tweets and our Under the Dome podcast for more developments.

— By Luciana Perez Uribe, reporter for The News & Observer. Email me at lperezu@newsobserver.com

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