Gov. Roy Cooper signs NC Medicaid expansion into law. But it comes with an asterisk.

It actually happened.

After years of negotiations between Democrats and Republicans, then just between Republicans, the General Assembly passed a bill last week expanding Medicaid in North Carolina. Democratic Gov. Roy Cooper signed the bill into law Monday in a ceremony at the Executive Mansion in downtown Raleigh, two blocks from the Legislative Building. He was joined by a bipartisan group of lawmakers and supporters.

The bill’s passage is a bipartisan victory, but Medicaid expansion’s implementation — providing health insurance coverage to 600,000 more North Carolinians — comes with a significant asterisk: Republican bill writers tied it to the state budget.

While some parts of the bill are effective upon signing, much of Medicaid expansion cannot roll out until the 2023 state budget passes. And that won’t be for another three months.

Passing the state budget has been a game of political football over the past several years as Cooper and General Assembly Republicans, who control the legislature, haggled over disparate policy priorities. This year is likely to be different with Republicans only one vote short of a veto-proof supermajority and Cooper incentivized to sign the budget because it includes Medicaid expansion.

Once the state budget becomes law, Medicaid expansion in North Carolina will start soon thereafter. Expansion will extend eligibility for the federal health insurance program to all adults with incomes up to 138% of the federal poverty level.