McCrory's prediction that state may be forced to expand Medicaid raises eyebrows

By Travis Fain/Greensboro News & Record

Gov. Pat McCrory said Monday that North Carolina may have to expand its Medicaid health insurance program, saying a back door in federal health reforms is forcing his hand.

Reform experts question his logic, though changes in the law give hospitals more power to approve Medicaid eligibility temporarily, potentially putting the state-and-federally-funded program on the hook for more patient bills.

McCrory’s comments came at The Heritage Foundation in Washington, D.C., where he discussed reforms made since Republicans won political control in North Carolina.

“We just got a new regulation that might force us to do Medicaid expansion whether we want to or not,” McCrory said. “I’m just as surprised as you. ... These are the difficult parameters of Obamacare.”

A spokesman for McCrory said the governor was talking about changes in Medicaid’s “presumptive eligibility” rules, which will give hospitals more leeway to assume people seeking care fit into various Medicaid-eligible categories. Previously, only pregnant women and newborns were presumed eligible. Obamacare expands that to include low-income parents, according to the governor’s office.

If a patient lies, or if a hospital gives temporary eligibility in error, Medicaid must pay for bills that mount until a full eligibility check is complete. That can take 60 to 105 days, the governor’s office said. The state’s Medicaid program already runs hundreds of millions over budget annually.

“You’re opening yourself up to all kinds of opportunities for fraud,” said Jonathan Ingram, research director for the Foundation for Government Accountability, a right-leaning think tank. “I think the governor has a point. I would say it probably won’t (force expansion), but it’s certainly going to lead to a bunch of headaches.”

Adam Linker, a health policy analyst for the left-leaning N.C. Justice Center, said any fraud would likely only affect emergency care. Temporary eligibility can’t be used to see a primary doctor or receive other routine care, he said. “I just don’t see how, in any way, it could be seen as forcing the state to expand Medicaid,” he said.

Tricia Brooks, who follows health care reform for the Georgetown University Center for Children and Families, said McCrory made it sound like the change lets a fox loose in the henhouse.

“It really isn’t an accurate description that presumed eligibility gives hospitals a back door to enroll anyone in Medicaid,” she said.

Democrats who wrote the health care reform law meant for Medicaid expansion to be mandatory. But the U.S. Supreme Court struck it down last year even as it held the rest of the law to be constitutional.

A number of states, including North Carolina, declined to expand Medicaid, citing cost concerns, potentially leaving hundreds of thousands of people without affordable insurance.

McCrory made that decision with fellow Republicans who control the General Assembly. He indicated the state might revisit its decision once previously existing problems with the state’s Medicaid program were under control.

An attempt to reach legislative leaders who oversee Medicaid wasn’t successful Monday. A spokeswoman for Senate President Pro Tem Phil Berger, R-Rockingham, declined to comment.