RALEIGH, N.C. (WNCN) – With North Carolina leaders on the verge of expanding Medicaid coverage to more than half a million people, Gov. Roy Cooper (D) called on hospitals this week to “step up and negotiate,” saying they’re holding up a potential deal.

While Republican legislative leaders now support expanding Medicaid after years of opposing it, they have not reached an agreement on exactly how to do that.

“Not only is failure to expand Medicaid costing lives, but it’s also costing the state $521 million a month,” Cooper said. “Delay here is unacceptable.”

Last month, Senate leader Phil Berger (R-Rockingham) said hospitals are being “intransigent” when it comes to proposed changes Republicans in his chamber want to make to the state’s laws known as “certificate of need” that could increase competition for hospitals.

A bill the Senate passed earlier this year not only would expand Medicaid but makes a variety of other changes to health care regulations, which Republicans said are needed to ensure people have access to healthcare services.

Cooper echoed Berger’s concern in an op-ed this week and spoke about the issue with reporters, saying hospitals aren’t compromising because they are concerned about their profits.

“I’m calling on the hospitals to step up and compromise with the state legislature on this issue, so that we can get Medicaid passed, we can get money coming into the state,” said Cooper. “It’s something most states have done, and it’s time for North Carolina to do it.”

Steve Lawler, president and CEO of the North Carolina Healthcare Association, which represents hospitals across the state, pushed back on the comments.

“The idea that hospitals are holding up the process or not doing our part, really is not accurate,” he said. “Medicaid expansion is something that our elected officials could have voted on a long time ago, and they don’t need hospitals in the chamber when they take that vote.”

His group has raised concerns about the reforms the Senate wants to make the state’s certificate of need laws, saying that could “hurt the stability of rural hospitals.”

“It’s a shame that the hospitals have become a political pinata for some of our elected officials,” Lawler said. “It really is a complex economic issue in regards to what services we provide in a hospital that help pay all the bills for everyone else.”

Republicans in the state House of Representatives declined to bring the Senate’s bill up for a vote during the recent legislative session, citing the various other provisions the Senate included.

A bill the House passed called on Cooper’s administration to negotiate an agreement with the federal government on Medicaid expansion first before the legislature would hold a vote at the end of the year. It did not include the other regulatory changes the Senate approved.

Neither chamber’s bill got to Cooper’s desk.

Since the session ended in early July, state leaders say there’s been little progress in reaching an agreement.

“We’re studying this and we feel confident that we can communicate what we think is reasonable relatively soon,” said Lawler. “We’re optimistic that this is going to get done. We’re working hard to make sure that whatever decisions are made are not harmful because at the end of the day we have an obligation to be there for our patients.”

North Carolina is among 12 states that has not expanded Medicaid coverage under the Affordable Care Act. The federal government covers 90 percent of the cost and has offered an upfront incentive of about $1.5 billion to the state to take that step. Legislative leaders have proposed using that money to increase access to mental health and substance abuse services.

“When pretty much everybody agrees that we ought to expand Medicaid in our state, it’s important to go ahead and get it done,” said Gov. Cooper.