The North Carolina General Assembly in Raleigh.
The North Carolina General Assembly in Raleigh. File photo by Angie Newsome/Carolina Public Press

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RALEIGH – Sponsors of new legislation that would increase Medicaid eligibility for about 375,000 low-income North Carolinians say their plan is a new way forward on a complicated and often politically charged issue.

North Carolina is one of 19 states that has not expanded Medicaid eligibility under the Affordable Care Act. After recent attempts to repeal the ACA faltered, many of those states are taking another look at Medicaid expansion.

Four Republicans introduced the new legislation in North Carolina, House Bill 662; they included Rep. Josh Dobson, R-McDowell. Like a bill that a group of Democratts previously introduced and a plan Gov. Roy Cooper put out earlier this year, the proposed Carolina Cares plan would take advantage of federal funding of expansion under the Affordable Care Act. But unlike the other attempts, the new effort comes from a key segment of the House caucus.

Along with Dobson the co-chairs of the House Health Committee, Reps. Donny Lambeth, R-Forsyth, and Rep. Greg Murphy, R-Pitt, are sponsors. They’re joined by Rep. Donna White, R-Johnston, a nurse. Another backer is House Appropriations Chair Nelson Dollar of Wake County.

Reaction so far has illustrated the difficulty of any change in the status quo. Both House Speaker Tim Moore and Senate leader Phil Berger said over the weekend that they are still opposed to Medicaid expansion.

The legislature officially prohibited both a state-operated exchange and Medicaid expansion under the ACA in 2013 with the passage of Senate Bill 4. The legislation put final say on changing Medicaid in control of the legislature, a provision that made it unlikely that Cooper’s recent push to expand Medicaid without legislative approval would succeed.

At last week’s news conference announcing the bill, HB662 sponsors were keenly aware that after years of strong opposition, the new plan would have to carry a label other than “expansion.” Instead, the proposal is being pitched as a new type of insurance option for low-income residents.

“This is an option, not a requirement,” Lambeth said. “It’s designed like many insurance products. Participants who fail to keep up with their premiums or coverage requirements lose coverage.”

The plan would require a waiver from the federal government to allow the state to set up its own system for raising eligibility to include people aged 19 to 64 who earn less than 133 percent of the federal poverty level. That’s about $16,000 for a single person, $21,500 for a couple and $33,000 for a family of four.

For those able to work, the plan requires employment or job-training. All recipients would pay premiums equal to 2 percent of the annual incomes and would have to agree to schedule routine preventive care.

Lambeth said the commitment to preventive care was a key difference.

“This product is unlike any other state in the nation,” he said. “It establishes a new health care paradigm in North Carolina rooted in consumerism and personal responsibility.”

Lambeth added that the plan is an economic win for the state. By providing coverage to low-income workers, demand for health services will increase, he said, adding jobs and shoring up rural health centers.

“This influx of health care services will benefit rural areas of North Carolina where many providers are already under a great deal of stress,” he said.

Dobson said the bill would help struggling rural areas.

“We have a lot of hard-working individuals who are uninsured,” Dobson said.

“This bill seeks a common sense solution to increase coverage in rural areas, rational accountability measures and finally just be able to increase access to care in underserved areas of the state like mine.”

Although the exact eligibility requirements could affect the total number of participants, the plan could affect as many as 375,000 residents.

Sponsors said they expect enrollment in Carolina Cares to be between 300,000 and 350,000.

A recent analysis of the various Medicaid plans by the North Carolina Institute of Medicine said HB662 would increase eligibility to roughly 375,000 residents. A snapshot by the institute of the eligibility based only on a slightly higher 138 percent of the federal poverty level put the total number in eligible 630,654 with the breakdown for WNC counties as follows:

  • Avery 1,374
  • Buncombe 16,922
  • Burke 6,606
  • Cherokee 1,912
  • Clay 776
  • Graham 782
  • Haywood 3,409
  • Henderson 7,014
  • Jackson 3,511
  • Macon 2,637
  • Madison 1,379
  • McDowell 3,101
  • Mitchell 992
  • Polk 1,286
  • Rutherford 4,713
  • Swain 1,069
  • Transylvania 2,101
  • Watauga 4,133
  • Yancey 1,069

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Kirk Ross

Kirk Ross was the former capital bureau chief for Carolina Public Press. To contact the Carolina Public Press newsroom, email

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