Medicaid expansion to begin soon in North Carolina as governor decides to let budget bill become law

North Carolina Gov. Roy Cooper announced Friday that he will let the state budget bill coming to his desk become law without his signature, clearing the way for Medicaid coverage for 600,000 low-income adults, with some receiving government health insurance within weeks.

The Democratic governor unveiled his decision on the two-year spending plan minutes after the Republican-controlled General Assembly gave final legislative approval to the measure.

A Medicaid expansion law signed by Cooper in March said the state budget for this fiscal year still had to be enacted before the coverage could be implemented.

Negotiations on this draft budget, which was due to take effect on July 1, continued throughout the summer.

The latest two-year plan accelerates individual tax rate cuts, expands private school scholarships to all K-12 children and contained other elements that weaken the governor's office while strengthening the GOP-dominated Legislature and its power in state courts.

Cooper could have signed the budget, vetoed it or let it become law after waiting 10 days. Cooper said Friday he would do the latter.

Republicans hold narrow veto majorities, and five House Democrats joined GOP lawmakers in voting for the budget measure.

Expanding Medicaid has been one of Cooper's top priorities since taking office in early 2017. For years, state Republicans have staunchly opposed the Medicaid offering through the federal health care law of 2010, but his leaders GOP changed course last year.

“Make no mistake, overall this is a bad budget that severely cuts our schools, prioritizes power grabs, keeps shady backroom deals secret and blatantly violates the constitution, and many of its provisions will face legal action,” Cooper said in a press release.

“However, we must recognize this irresponsible legislature's decade of refusal to expand Medicaid, which has caused life-and-death situations for so many North Carolinians and threatened the very existence of many rural hospitals,” he added. “I will not allow the people crying out for help to wait any longer, so I am directing our Department of Health and Human Services to begin the process today to expand Medicaid while allowing this budget to become law without my signature.”

Cooper's health secretary suggested last month that Medicaid coverage could take place as soon as December if the Legislature completes the last step on Medicaid.

Adults who earn too much to qualify for traditional Medicaid but too little to get even heavily subsidized private insurance would benefit from the expansion. About half of that total could be taken up immediately, Secretary Kody Kinsley said.

The House and Senate voted Thursday and Friday on the plan that determines how $29.8 billion is spent this fiscal year and $30.9 billion next year.

Senate Leader Phil Berger told reporters after Cooper's announcement that he would prefer the governor sign the budget “to move things along a little bit faster,” rather than wait until early October to pass the budget.

“But I think that's an indication that this is a stable budget,” Berger said. “There are some things in the budget I'm not so crazy about … but on balance, it's in many ways the most important budget we've seen in North Carolina.”

The future of North Carolina's soon-to-be expansion was uncertain earlier this week as GOP legislative leaders proposed moving the trigger to begin the expansion away from the budget and into a standalone measure that would dramatically expand gambling in the state.

But Cooper and both legislative Democrats and conservatives balked at the idea, threatening the bill's success. Berger and House Speaker Tim Moore abandoned that effort earlier this week.

North Carolina was among 11 states that had not accepted the expansion from the federal government before Cooper signed the expansion bill. Cooper and his administration had complained that implementation delays meant the state was missing out on more than $500 million a month in additional federal funding.

The state government will also receive an additional two-year, $1.8 billion federal payment to expand Medicaid.

The state's 10% share of costs for Medicaid expansion recipients will be paid through hospital assessments.

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Associated Press/Report for America writer Hannah Schoenbaum contributed to this report.