The funding plan is intended to support the Medicaid program and the millions of North Carolinians who rely on it. However, the bill also includes new oversight measures, including one tied to immigration status.
Under newly added language that would take effect in October, the Department of Health and Human Services would be required to "refer any applicant or recipient for which citizenship or satisfactory immigration status could not be verified to the U.S. Department of Homeland Security or any other federal authority for investigation and enforcement."
Immigration advocates say the provision could discourage people from seeking medical care, particularly in families with mixed immigration status.
"What we do know is that this provision in this proposal, like, just really undermines trust between immigrant communities and public institutions, not just in this instance, but for years to come," said Andreina Malki of Siembra NC. "And we think that health care access for children should not depend on whether their parents fear being deported to federal immigration authorities or not."
On Tuesday, House Speaker Destin Hall said the oversight language is necessary as part of broader reforms included in the bill, saying, "Medicaid should serve the people who truly need it, and this bill makes sure that happens."
Immigration lawyers question whether the provision is needed or legally sound. They noted that people without legal immigration status are not eligible for government benefits and say the requirement could place medical and social service workers in a difficult position.
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"The people who don't have status, they can't apply for Medicaid anyway. And if they did, it would just be denied," said Trey DeBrine, a lawyer with Sivaraman Immigration Law. "I'm sure that there are much like voter fraud, some instances of people trying it, but it happens so, so few and far between that it doesn't really come up. So it looks like we're looking for a solution to a problem that just isn't there,"
DeBrine added that the provision could raise privacy and constitutional concerns if challenged in court.
"There may be rights to privacy and certain civil rights under the Constitution for privacy that could protect people from this," he said. "I don't know that this would necessarily stop under a court case, given the current state Supreme Court and our federal Supreme Court."
Lawmakers must now decide whether that provision could affect the passage of the overall bill. The Medicaid funding agreement has been heavily negotiated, has received bipartisan support in the legislature, and is a priority for the governor. A final vote on the bill is scheduled for next week.