Gov. Pat McCrory suggested Monday that new federal regulations could force North Carolina to expand Medicaid eligibility to more low-income people under the Affordable Care Act.
McCrory spoke in Washington at an event held by The Heritage Foundation, a conservative think tank.
Medicaid spokeswoman program Emma Sandoe said Monday the regulation McCrory was referring to has nothing to do with forcing the state to expand eligibility for the health care program. The rule concerns how hospitals treat certain patients and bill the government for it.
During the event carried on an online video feed, McCrory was asked about why North Carolina was one of 26 Republican-led states to reject expanding Medicaid coverage to low-income workers, even though all costs would be paid by the federal government for the first three years. After that, states would have to cover up to 10 percent of the costs.
McCrory said he was concerned about the uncertainty of how much the expansion might cost the state in future years. It has been estimated up to 500,000 low-income North Carolinians might have qualified for coverage under the new program.
"Even in the last four or five weeks, the administration is sending us new regs on Medicaid, and no one is talking about it," McCrory said. "We just got a new reg which might, in fact, might force us to do Medicaid expansion whether we want to or not in the upcoming year."
McCrory spokesman Ryan Tronovitch later clarified that the governor was referring to Section 2202 of the Affordable Care Act, which allows the federal Centers for Medicare & Medicaid Services to issue regulations expanding the ability of hospitals to presume some patients not already enrolled for federal assistance are likely to qualify for benefits.
Under longstanding Medicaid rules, hospitals can bill the government for the care of those patients, such as pregnant women and newborn babies, for up to three months until a final determination about their eligibility is made.
"Basically if a person goes to the hospital and say they cannot pay for it, and they might not even qualify for Medicaid, they can still sign up for Medicaid," McCrory said. "After two months, if the state finds out that they did not qualify for Medicaid then that person can be taken off Medicaid. But the state still has to pay for that two months. And that is two months of tests and services we did not have budgeted."
Under the new regulation issued on July 5, hospitals can expand the groups of people it presumes to qualify for benefits, such as low income women with breast or cervical cancer.
Sandoe stressed that hospitals preemptively determining an individual's eligibility must adhere to state-specific rules for determining who qualifies for benefits. If a particular hospital makes too many errors with those determinations, the state can bar that facility from participating in the program, she said.
Low-income workers that would have been covered under the Medicaid expansion rejected by North Carolina would not gain coverage due to the rule change referenced by McCrory, Sandoe said.