Steps to Medicaid expansion in NC? A legislative committee wants to find a “North Carolina solution.”

A legislative committee is diving into the details of medical insurance and health-care industry forecasts, a task that may lead to recommendations on how to get health insurance for more North Carolinians.

North Carolina is one of 12 states that has not expanded Medicaid under the Affordable Care Act. In North Carolina, most childless adults do not qualify for Medicaid, no matter how low their income.  Parents do not qualify unless their income is about 40% below poverty level. These adults are said to fall into a “coverage gap” because they don’t qualify for Medicaid and make too little to qualify for subsidized premiums through the ACA insurance marketplace.

According to a Kaiser Family Foundation report last year on all states that have not expanded Medicaid, nearly two-thirds of the adults without insurance live in a household where someone is working, and nearly half are working themselves.

The focus for North Carolina Republicans considering options for the uninsured is on developing a “North Carolina solution.”

“We have a large number of uninsured people,” said Sen. Kevin Corbin, a Republican representing seven counties in western North Carolina. “We need to get those people insured. How to do that is the question.”

Corbin is a member of the Joint Legislative Committee on Access to Healthcare and Medicaid Expansion, which had its first meeting Friday.

Corbin wants to look at a range of options for insuring more people and had specific questions about expansion in Arkansas. That state uses federal funds for Medicaid expansion to help people pay private insurance premiums.

Over the years, Republican leaders have offered a host of reasons for not expanding Medicaid since a 2012 U.S. Supreme Court decision made expansion optional under the ACA.

Republican legislators said Medicaid was “broken,” pointing to years when spending outpaced budget projections.

They said they were worried that the federal government would rip away financial support. The federal government now pays 90% of the costs for people who enroll in Medicaid through expansion.

Republicans wanted to wait for what’s called “Medicaid transformation,” or the conversion from a fee-for-service insurance coverage to a largely managed care program. The state converted to Medicaid managed care last year.

Republican Sen. Joyce Krawiec, who represents a district that includes Davie and Forsyth counties, has written and spoken critically of Medicaid expansion over the years.  She is leading the Access to Healthcare and Medicaid Expansion Committee with House Rep. Donny Lambeth, a Winston-Salem Republican who has been strategizing for years on ways to get health care coverage for more uninsured adults.

Krawiec said Friday that she was not opposed to Medicaid expansion, but wanted to wait until Medicaid transformation was accomplished before seeking a state-specific solution to expanding health coverage.

“I was an opponent of expanding before we went to managed care,” she said after the meeting. “I always said we need to get through that before we talk about Medicaid expansion. We’re here to learn all we can about what’s worked in other states – what we need to do to create a plan for North Carolina that’ll work for our residents. We hope to find a North Carolina specific plan that will work for us. That’s our goal.”

The federal government pays nearly 74% of the state’s Medicaid costs now. The federal government added a sweetener last year for states that have not yet expanded, which in North Carolina would mean another $1.5 billion to $2 billion coming to the state. North Carolina would have to spend that money on Medicaid costs, but it would free up cash in the state’s general fund that could be put to other uses, legislators said.

Lambeth said he wants to get a recommendation prepared and approved by the legislature in September or October, with the goal of getting something implemented in the first three months of next year.

Gov. Roy Cooper has pushed for expansion for years. Medicaid expansion was part of last year’s budget negotiations, but the idea couldn’t get past the House Republican caucus.

“It is a heavily lift to convince our House caucus that this is the right direction to go,” Lambeth said Friday after the meeting. “Now is it impossible? No. I wouldn’t be here if I thought it was impossible.”

The committee needs to do a lot of groundwork and fact finding to answer the questions about financial sustainability and meeting an increased demand for care from the newly insured, he said.

“I need to be able to answer those questions for the House caucus,” Lambeth said.