One of the most contentious political issues in Raleigh for the past decade, Medicaid expansion, has finally been resolved.

The Medicaid expansion bill got final approval in the legislature when it passed the North Carolina state House on Thursday, March 23.  Democratic Gov. Roy Cooper has said that he will sign the bill into law.

Cooper has been pushing for Medicaid expansion since before he was elected governor the first time in in 2016. Now, halfway through his second term, Cooper is finally getting, if not exactly what he wanted, at the very least a Medicaid expansion bill he can live with.

In 2019, Cooper vetoed the budget passed by the Republican-led legislature mainly because it didn’t include Medicaid expansion.  The Republicans refused to add Medicaid expansion to the budget but couldn’t come up with the votes to override Cooper’s veto in the state Senate.

The result was the state continued spending based on the 2017 budget plus some budget amendments until Cooper signed the budget in 2021 with the agreement that the legislature would work on a Medicaid expansion bill.

Both the Republican-led House and the Republican-led Senate passed different Medicaid expansion bills in 2022, but couldn’t agree on a compromise bill.  Early in March, state House and state Senate leaders announced they had reached an agreement.

The Medicaid expansion bill will allow adults who make below 138 percent of the federal poverty level to qualify for Medicaid coverage.  The estimate is that this will make over 600,000 more North Carolinians eligible for Medicaid coverage.

The federal government will pay 90 percent of the cost of the additional coverage and a fee charged to hospitals will cover the remaining 10 percent.

Even after Cooper signs the Medicaid expansion bill, it’s not quite done deal because Medicaid expansion is tied to the 2023 state budget, so it won’t go into effect until the budget is passed by the legislature and signed by Cooper.

With Cooper so adamantly in favor of Medicaid expansion, this gives the legislature another card to play at budget time.  Would Cooper veto a budget over pay raises or tax cuts and delay Medicaid expansion going into effect?  Only time will tell.