Earlier this year, the state legislature voted down the idea of expanding Medicaid eligibility to people earning up to 138 percent of the federal poverty level under the Patient Protection and Affordable Care Act. However, Gov. McCrory said a federal regulation under the reform law that allows hospitals to presume Medicaid eligibility could hurt the state financially if it doesn’t expand health insurance coverage for low-income residents, according to the report.
Under the regulation, hospitals are allowed to make “presumptive eligibility” decisions to ensure people who are eligible for Medicaid but not enrolled can gain coverage if they come to the hospital for care. Hospitals can bill the state for the care of those patients for up to two months until a final determination is made, and the state still has to pay for that care even if the eligibility determination is incorrect, the governor said, according to the report.
A CMS spokeswoman told the Observer hospitals are still required to follow the Medicaid criteria in their state, and the regulation doesn’t permit them to give “presumptive eligibility” to patients who would have qualified under the expansion in states that don’t extend their Medicaid programs.
The state legislature still has the final say on Medicaid expansion under North Carolina law, according to the report.
More Articles on Medicaid Expansion:
Ohio Panel Approves Medicaid Expansion
Iowa Medicaid Initiative Saves $41M in 2013
South Dakota Physicians Call for Medicaid Expansion
