RALEIGH, N.C. (AP) — North Carolina House Republicans pitched a plan Thursday that could authorize expanding Medicaid to hundreds of thousands of additional low-income adults, which their leader argued would bring more certainty to ensuring rural hospitals and substance abusers get help.

The legislation is being promoted by Speaker Tim Moore, who said it was a response to a wide-ranging health care access bill backed by GOP Senate leader Phil Berger that contains expansion and received overwhelming bipartisan support earlier this month.

Although many House Republicans don’t like the Senate bill because it also contains too many controversial topics unrelated to expansion, Moore said he hoped offering an alternative would keep talks going.

“I don’t know if the other chamber will agree to it or not,” Moore told the House Health Committee, but “this is a way to move forward with a plan that I think will actually help at the end of the day without causing the state any financial hit, and at the end of the day help those who need help the most.”

Expansion has been intertwined with ongoing but separate negotiations between the House and Senate over proposed adjustments to the second year of a two-year state budget approved last fall. Berger has said Medicaid expansion ought to be inserted in the budget, something that Moore isn’t willing to do.

Although lawmakers hope to end the legislative work session on or around July 1, the date the new fiscal year begins, they aren’t required to adjourn. Moore and Berger met Thursday to work out difference that their lieutenants couldn’t resolve. They said they still hoped to vote on budget legislation next week.

North Carolina is one of 12 states that haven’t expanded Medicaid through what the federal 2010 Affordable Care Act offers to people making up to 138% of poverty guidelines. Republican legislative leaders were skeptical of expansion for years, saying they couldn’t trust Congress to keep covering 90% of the expenses. But that federal portion hasn’t changed and the federal government has offered additional financial sweeteners that would give North Carolina an additional $1.5 billion over two years to treat traditional Medicaid recipients.

Unlike the Senate proposal, the House plan doesn’t accept expansion right away. Rather, it directs the state Department of Health and Human Services to develop a “Medicaid Modernization Plan” that includes expansion.

A panel of 12 legislators would then review the plan in mid-December and make recommendations to the full General Assembly, which soon after “shall take action” to implement all or part of the plan in the form of legislation. Moore said he expected votes would be taken before a new edition of the General Assembly takes its seats in early 2023.

Though Moore said it’s possible legislators still will reject the expansion plan, he called the proposal the best approach he’s seen to help them understand what expansion is expected to accomplish. Otherwise, “they really don’t know what they’re voting for. They’re buying a car without a test drive.”

The idea would be for DHHS, an agency in Democratic Gov. Roy Cooper’s administration, to negotiate with the Centers for Medicare and Medicaid Services on a Medicaid plan for North Carolina that would meet at least eight designated benchmarks. They would include projections that the existing state Medicaid program would save money, proposals to increase preventive health care and medical services in rural areas, and spending $1 billion of the $1.5 billion to address the state’s “opioid, substance abuse and mental health crisis.”

Berger is skeptical of the House proposal, pointing out that a legislative commission already studied expansion and other health care access issues earlier this year.

“So, the House has gone from ‘No,’ to ‘Let’s study it again,'” he said in a written statement. “It is past time for action.”

Rep. Jimmy Dixon, a Duplin County Republican and Medicaid expansion skeptic, said Thursday that he thinks the proposal “threads the needle, and I’m willing to support this approach,” he said. The committee didn’t take a vote Thursday.

Cooper has been a strong Medicaid expansion advocate since taking office in 2017, going so far as to veto a 2019 budget bill because expansion wasn’t addressed. That led to a spending stalemate with Moore and Berger that never got fully resolved. Cooper would be asked to sign Moore’s bill or any expansion plan approved by legislators that reaches his desk.

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