House Speaker Tim Moore and Senate leader Phil Berger, both Republicans, spoke Thursday announcing a compromise that they say will pass through North Carolina's General Assembly.
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The deal, which likely won't be voted on until later this month, marks a milestone for Republicans, most of whom opposed the idea until recently for close to a decade.
North Carolina has been one of 11 states that have not adopted Medicaid expansion.
Under the agreement details, which also include easing "certificate of need" laws that require health regulators to sign off on expansion plans by medical providers, the state would start enrolling people in January.
"This is something that we can all be very proud of," Moore said at a Legislative Building news conference with Berger. "What a huge announcement this is for North Carolina. What a huge policy direction this is, that will provide help for so many in this state, but it's going to do it in a way that's fiscally responsible."
The federal government covers 90% of the cost of Medicaid recipients under expansion. Potentially, 600,000 people in North Carolina could receive the benefit - those who make too much to qualify for conventional Medicaid but not enough to receive the heavily subsidized health insurance that the 2010 law provides.
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Under the agreement, the state's 10% share would be paid through assessments paid by hospitals, which in turn benefit from getting reimbursed as they cover patients with Medicaid.
The state also could get an extra $1.5 billion over two years through a financial sweetener in a COVID-19 federal relief package if it accepts expansion. And Berger said the package will include provisions that would result in higher reimbursements - potentially $3 billion annually - for hospital systems when they treat Medicaid patients.
Gov. Roy Cooper, a Democrat, has long been a supporter of expanding Medicaid -- even using it as a campaign talking point during his last election.
"An agreement by legislative leaders to expand Medicaid in North Carolina is a monumental step that will save lives and I commend the hard work that got us here. Since we all agree this is the right thing to do, we should make it effective now to make sure we leverage the money that will save our rural hospitals and invest in mental health. I look forward to reviewing the details of the bill," Cooper said in a statement.
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Medicaid has long been a sticking point between Republicans and Democrats in North Carolina. In fact, disagreement over Medicaid was the central reason the General Assembly and Cooper could not pass a new budget for the state in 2019.
The North Carolina Department of Health and Human Services called the agreement "momentous" and said that it will "directly improve the health and well-being of 600,000 North Carolinians."
"We applaud the efforts by the General Assembly to move this forward," NCDHHS said. "Medicaid expansion will be transformative for access to health care in rural areas, for better mental health and for veterans, working adults and their families. For these people, today's agreement is life-changing.
According to our newsgathering partners at the News and Observer, Moore and Berger have not talked to Cooper about the compromise they say will pass through the General Assembly.
Moore and Berger said the agreement would not take effect until after a state budget is enacted, likely in the early summer.
"What a huge announcement this is for North Carolina. What a huge policy direction this is that's going to provide help for so many in this state. But it's going to do it in a way that's fiscally responsible," said House Speaker Tim Moore.
The cost of expansion has long been a source of sticking points behind a refusal to expand Medicaid.
"When you put a pen to the back of the napkin, it's a net break even at worst, a net positive frankly if you do the math on it," said Moore, behind the deal.
Daniel Lipparelli, CEO of Neighbor Health, says they currently have about 1,500 uninsured patients.
"That's going to relieve the financial strain that these patients may have for healthcare for their family. It is going to improve and increase the different services they would qualify for," Lipparelli said.
"When you're talking about those competing financial obligations that families have, that discussion of 'do I put food on the table or do I try to go see my primary care doctor or refill this prescription,' that stress and anxiety that households feel will likely be relieved," added Dr. Ciara Zachary, an Assistant Professor at UNC Gillings School of Public Health.
It comes in the midst of a regionalization of healthcare coverage, which has led to the closure of health centers in smaller communities.
"We know that in states that have closed their coverage gap through Medicaid expansion have seen a stabilization in the health and health care marketplace and specifically regarding rural hospitals," said Peg O'Connell, Chair of Care4Carolina.
"We have over a decade's worth of data now that shows that in states that have expanded Medicaid, that health outcomes increased, that premature deaths decreased, and especially health inequities decreased for black and brown communities, and low-income communities," added Felicia Burnett, National Director for Storytelling Innovations and Healthcare with MomsRising.
SEE ALSO: Why Medicaid Expansion previously pushed lawmakers to their corners
ABC11 360: Why Medicaid Expansion is pushing lawmakers to their corners
The Associated Press contributed to this report.