Brooks Pierce Capital Dispatch: Legislators Announce Medicaid Expansion Deal


Legislative leaders this week announced an agreement on Medicaid expansion in addition to continuing work on the state budget bill and considering other bills.

Medicaid Expansion

If enacted, the agreement to expand Medicaid will provide health insurance coverage to hundreds of thousands of North Carolinians. It could resolve years of debate on this topic. Gov. Roy Cooper has advocated for expansion for a number of years and both houses passed a version of it in 2022 but could not agree on details.   

The agreement is expected to surface as a bill next week. Legislative leaders indicated that expansion might be tied to enactment of a state budget bill, which often occurs around June 30, the end of the fiscal year. Other health care issues are expected to be in the bill. These include the Healthcare Access and Stabilization Program (HASP), which could bring a significant amount of federal health care funds to North Carolina, and a reduction in the number of Certificate of Need (CON) approvals. CONs require hospitals and other health care entities to get state approval before certain construction projects and equipment purchases. 

Gov. Cooper praised the agreement and met with legislative leaders on Thursday afternoon to discuss it. He has stated a preference for enacting expansion now instead of it being finalized in the state budget bill later in the year.

Budget Bill Work

Legislators this week continued work on the state budget bill. In odd-numbered “long session” years, they seek to enact this bill by July 1, the beginning of the new fiscal year.

Members have been meeting jointly in Appropriation Committee subcommittees since early February. In these meetings, legislative staff and state agency representatives are providing information and answering questions. The House will soon begin working separately on the budget bill since that chamber will consider it first this year. Speaker Tim Moore has indicated he hopes the House will pass it by Easter. Gov. Cooper is expected to send his budget recommendations to the General Assembly in March. His State-of-the State speech will be delivered at the General Assembly on March 6.

It appears there will be significant funds available for appropriation as shown by recent revenue projections. The Consensus Forecasting Group, comprised of economists at the Office of State Budget and Management (its Director is appointed by Gov. Cooper) and the General Assembly’s Fiscal Research Division, estimates tax collections in FY 23 (current FY) $3.25 billion higher than projected.

Medical Marijuana

The Senate this week passed S 3, a bill to legalize cannabis (marijuana) for certain medical purposes. The vote was 36 to 10 with a majority of Republicans and all the Democrats who voted supporting it. The bill now goes to the House where it may get more serious consideration than in 2022.

The bill authorizes a doctor trained in prescribing medical cannabis to prescribe it for certain “debilitating medical conditions” such as cancer, epilepsy, Crohn’s disease, HIV/AIDS, sickle cell anemia, amyotrophic lateral sclerosis (ALS), Parkinson’s disease and post-traumatic stress disorder (PTSD). A Compassionate Use Advisory Board created in the bill could add to this list. A new Medical Cannabis Production Commission would award supplier licenses to 10 entities (each could open up to eight medical cannabis centers across North Carolina) that could grow, process and sell cannabis. Patients or caregivers would register with the NC Department of Health and Human Services.

Information about bills and work of the General Assembly can be found at its website:

For more information, contact a member of the Brooks Pierce Government Affairs Team.

Ed Turlington, Partner
Drew Moretz, Government Relations Advisor
Katelyn Kingsbury, Government Relations Advisor

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