Medicaid expansion is another step closer to becoming reality for thousands of low-income North Carolinians with no health insurance.
Wednesday afternoon, the state Senate gave final approval to the bill by a vote of 44-2. It now heads back to House to work out differences.
If signed into law, it could mark a huge help for people struggling with drug addiction but who can't afford treatment. It's called the coverage gap: 600,000 North Carolinians too poor to qualify for the Affordable Care Act but not eligible for Medicaid because the state hasn't enacted Medicaid expansion.
After years of protests and political stalemates, there's finally a deal in North Carolina.
"This is a historic moment for our state," said Gov. Roy Cooper as he announced his budget recommendations on Wednesday morning.
"What a huge policy direction this is that's going to provide help for so many in this state," House Speaker Tim Moore said earlier this month in announcing the long-awaited Medicaid expansion deal that fills the coverage gap for uninsured adults -- including thousands with substance use disorders.
"When they call me, they say, 'I need help and I don't have any money,'" Freida MacDonald said about a sentiment she hears every day at her new job at the Alcohol and Drug Council of North Carolina.
The Cary mom has been on the frontlines of the fight for Medicaid expansion since losing her two sons. Her eldest Stephen was shot and killed in a 2012 robbery. Four years later, her youngest, Michael, overdosed on fentanyl that he believed was heroin.
MacDonald honored her sons and dozens of other overdose victims with billboards across the state; putting their portraits on display. She sees Medicaid expansion as a game-changer that could stem the tide. A 30-day inpatient treatment program costs between $5,000 to $20,000.
"The money is one of the biggest challenges about it," MacDonald said. "Without Medicaid expansion, they can't get the type of long-term treatment that we're talking about."
Overdose deaths statewide increased 22% in 2021. 4,041 people died.
"We've seen an increase of 10,000 people accessing the (substance use) services. The good thing is people are accessing the services, but it also potentially indicates that more people are needing services," said Kelly Crosbie, Director of the NC DHHS Division of Mental Health, Developmental Disabilities and Substance Use Services.
But Medicaid expansion is not a silver bullet. Federal data shows all but three of the state's 100 counties are seeing shortages of mental health resources - begging the question: if there is a surge of new low-income substance use disorder patients who suddenly have healthcare coverage, are they going to be able to find it?
"We are working on that really hard," Crosbie says. "It's not just, yay, everyone has coverage now. We're looking at everything from the rates to the workforce that we have. We need to have the right incentives in place in our state facilities to be able to hire more people."
Back at Freida MacDonald's home, she recalled her late son Stephen's favorite phrase, "You gotta know hope."
Know Hope now serves as the name of MacDonald's non-profit. It's also a new life purpose.
"Just like Medicaid expansion, it's something new," she said. "We can't give up. We gotta keep going."
After one more vote in the House, the Medicaid expansion bill could be on the governor's desk in a matter of days. Then all eyes turn to the state budget. There can't be Medicaid expansion without a spending plan. A budget deal is likely months away.