NC hospitals open to expansion plan


By Jon Hawley
Staff Writer

Monday, January 9, 2017

Area hospital officials are reserving comment on Gov. Roy Cooper’s plan to have hospitals pick up North Carolina’s share of the costs of his plan to expand Medicaid coverage to an estimated 500,000 uninsured state residents.

Sentara Albemarle Medical Center officials declined to comment on Cooper's plan last week, although hospital President Coleen Santa Ana has previously supported expanding Medicaid in the state.

Similarly, officials with Vidant Health, the Greenville-based health care firm that owns Vidant Chowan Hospital in Edenton, didn’t comment specifically on Cooper’s plan, saying only in a statement that they support “affordable coverage options.”

An official with the N.C. Hospital Association, however, said Thursday that her association supports the expansion Cooper has called for, but wants to work in a bipartisan way to achieve it.

Asked if hospitals would help pay for the expansion, as Cooper as proposed, Hospital Association Vice President of Communications Julie Henry said her members are open to the idea.

“We've not closed the door to that,” she said, noting that hospitals already help pay for the Medicaid program in North Carolina.

Henry explained hospitals pay provider taxes to supplement the state’s match for Medicaid and bring in federal dollars for both hospitals and other health care organizations. Hospitals actually pay more toward hospital-based Medicaid care now than the state does, she added.

Hospitals' willingness to pay for a Medicaid expansion will depend on potential changes to health care, she said. Hospitals only have “inklings” of how the Affordable Care Act might be repealed and replaced, she said. Republicans have discussed turning Medicaid into a block grant program, which would mean North Carolina would only get a set amount of annual funding for it. Hospitals might not benefit as much from contributing to block grants, she said.

Asked about the ACA, better known as Obamacare, Henry said the law needs improvements but overall has been positive for hospitals. Hospitals are now concerned that many Americans will lose health insurance if the law’s repealed.

Also asked about Cooper’s plan, Robin Rudowitz, associate director on Medicaid and the uninsured for the Kaiser Family Foundation, said states vary in what their governors can do through executive action. Whether Cooper will be successful will depend on the state's legal system, she said, acknowledging the matter may end up in court.

There's also the question of whether the federal Centers for Medicare and Medicaid Services will approve a Medicaid expansion in North Carolina without the General Assembly committing to provide matching funds. Cooper said last week he will ask the CMS to approve an amendment to the state's Medicaid plan that expands coverage under the health insurance program for the poor and elderly.

Rudowitz said CMS does not require states to prove how they'll pay for a Medicaid plan amendment before it's granted. The CMS provides federal funds only to reimburse what states have already spent, she said.

Medicaid also works only as a state-federal matching program, Rudowitz said. That means providers could not relieve North Carolina of its funding obligation by accepting only what the federal government would pay.