Budget Delay Postpones North Carolina Medicaid Expansion

Aug. 29, 2023
General Assembly tied Medicaid expansion launch to the enactment of a state budget, which remains unresolved

North Carolina’s Medicaid expansion, which was expected to launch Oct. 1, will be delayed because the state General Assembly failed to take needed budgetary action to meet that date.

In March, bipartisan majorities in the North Carolina General Assembly passed legislation expanding Medicaid, putting North Carolina on a path to provide access to care for more than 600,000 North Carolinians. Since that time, the North Carolina Department of Health and Human Services (NCDHHS) has been completing the policy and technical work necessary to launch and working with partners to be ready on day one. However, the Republican-controlled General Assembly tied Medicaid expansion going live to the enactment of a state budget, which at that time, was expected to be enacted by June 30. NCDHHS announced that if NCDHHS had final authority to move forward with expansion by Sept. 1 — either through the budget or a different piece of legislation — Medicaid expansion would launch on Oct. 1.

NCDHHS said it has been working diligently to be ready for Oct. 1. But the department says it is confident that legislators will not sign a budget in August, nor pass separate legislation giving the final authorization to provide expanded Medicaid coverage.

A new launch date will be announced following the needed legislative action, but it will not be Oct. 1. At a press conference NCDHHS Secretary Kody H. Kinsley said the launch data could be in December or even in 2024.

"The delay tragically results in hundreds of thousands of people not being able to access care when they may need it most. Nearly half of the people eligible for expansion would be automatically enrolled in full coverage on day one," said Kinsley in a statement. "Each month of delay costs the state hundreds of millions of dollars flowing into communities across North Carolina to support care and treatment for people and help keep providers’ doors open."

A new launch date will not be determined until the General Assembly provides final authority. Without more clarity on when that will occur, NCDHHS said it is not able to commit to a timeline beyond its control. Work, however, will continue so that NCDHHS, county and community partners are ready to go live as soon as possible. Unfortunately, the department said, this delay will further strain providers who are gearing up to serve people who would be newly eligible.