Medicaid expansion allows 600K to add health insurance
ASHEVILLE – For years, many North Carolinians who became sick and did not have insurance faced impossible decisions: cut back on necessities to fund treatment or forgo health care, hoping that the illness would resolve itself.
Many of those who did not qualify for insurance were stuck in the state’s coverage gap. They earned too much to qualify for Medicaid, the state-run health insurance program for people with low incomes, and not enough to access health insurance through the open marketplace. Previously, Medicaid enrollees in North Carolina had to prove disability to qualify for health insurance, which can be difficult for people without documented medical history.
Starting Dec. 1, more than 600,000 North Carolinians will have newfound access to health insurance through Medicaid expansion, making the Tar Heel state the 40th to implement the policy.
“Medicaid expansion in our state has been the missing piece,” Pisgah Legal Services Regional Director Jessi Stone told the Citizen Times Nov. 29. Pisgah Legal Services is a legal aid organization based in Asheville. “It’s preventing people from getting that care they need when they need it.”
Medicaid expansion increases eligibility for the insurance program to adults making 138% of the federal poverty level. For a single household, that’s $20,120 per year. It also removes the disability requirement.
Medicaid expansion became a political football in Raleigh. Gov. Roy Cooper signed the legislation into law March 27, but a provision in the bill tied expansion’s implementation to the legislature approving the 2024 fiscal year budget. Cooper opposed the provision at the time.
Republicans, who control the state House and Senate, dragged budget negotiations into late September, presented the governor with a bill that he allowed to become law without his signature, noting that expanding Medicaid was too important to delay.
“Make no mistake, overall this is a bad budget that seriously shortchanges our schools, prioritizes power grabs, keeps shady backroom deals secret
and blatantly violates the constitution, and many of its provisions will face legal action,” Cooper said in a Sep. 22 statement. “However, we must recognize this irresponsible legislature’s decade of refusal to expand Medicaid, which has caused life and death situations for so many North Carolinians and threatened the very existence of numerous rural hospitals.”
Since the budget became law, the North Carolina Department of Health and Human Services has been working quickly to make the budget law before the new year. NCDHHS Secretary Kody Kinsley told the Citizen Times Nov. 30 that the state moved quickly so residents could access health insurance and to time the program with the open enrollment period for healthcare.gov. The timing also allows enrollees losing Medicaid coverage as states resumed certification following the pandemic to slide onto another plan.
“We’re trying to use this moment to get as many people as covered as possible,” Kinsley said.
Expanding the number of individuals with access to health insurance will create more patients for doctors who have limited availability. The hottest reservation in Asheville is not at any of the city’s acclaimed restaurants, but for a primary care doctor appointment, which can sometimes take months to schedule.
“The provider networks are not as strong as they need to be, and we’re adding 600,000 people to the rolls” Buncombe County Department of Health and Human Services Economic Services Director Phillip Hardin told the Citizen Times Nov. 29. “I know I’ve waited six months to get appointments with doctors. Our provider network needs to be strengthened tremendously as we add more people with health insurance across the state.”
Kinsley attributed limited spots for physicians partially to the high number of patients without health insurance in the state. Caring for people without insurance, he said, has led to uncompensated work. This, he said, impacts physicians, providers, Federally Qualified Health Centers and Community Health Centers, which often care for uninsured patients on sliding scale rates: Patients who make less pay less.
Kinsley also said that Medicaid reimbursement rates have not been high enough. He pointed to the state’s recent announcement to increase Medicaid behavioral health reimbursement rates as an example of progress. He wants to extend these increases across other care areas.
“A lot of our rate schedules have been frozen for a very long time, and that’s something I want to fix,” Kinsley said.
Expanded Medicaid does not extend to everyone in North Carolina. Undocumented individuals will not have access to the program, except for a few instances like labor and delivery. This persists for all states that have expanded the program.
Stone said that FQHCs and CHCs are options for people without documentation. She pointed to Vecinos,
a nonprofit organization in Western North Carolina that serves uninsured, low-income adults in WNC, as an option.
Kinsley said that NCDHHS has a call center (888245-0179) where individuals can ask about their eligibility for Medicaid. None of the information that people convey is reported or shared, he said.
People who were on the state’s Medicaid Family Planning program, which was dedicated to reproductive health, contraceptive services and family planning, received notifications that they were automatically enrolled in expanded Medicaid, according to a recent NCDHHS news release.
Health coverage begins on the day individuals apply for Medicaid. Coverage can be retroactive for the three months prior to applying going back as far as December 2023.
Signing up for Medicaid
Residents can apply to Medicaid using the state’s ePASS website (ePASS.nc.gov). Applicants will need to provide their full legal name, date of birth, Social Security number, North Carolina address and income information. Residents may receive letters in the mail from their local department of social services office requesting additional information.
Those who prefer to apply in-person can visit their local DSS office.
A list of documents that people may need to bring can be found at medicaid.ncdhhs.gov.
Mission Health will be holding open houses to help individuals verify their eligibility and apply for Medicaid benefits. Those events will be:
● Dec. 6 from 5-7 p.m. at the Asheville-Buncombe Technical Community College Conference Center, 16 Fernihuster Drive, Asheville.
● Dec. 7 from 2-5 p.m. at the A-B Tech Conference Center.
● Dec. 13 from 1:30-4:30 p.m. at the Salvation Army, 204 Haywood St., Asheville.
● Dec. 16 from 10 a.m.-1 p.m. at Mission Pardee Health Campus, 2695 Hendersonville Road, Arden.
Buncombe County is hosting its own enrollment event Dec. 12 from 11 a.m. to 1 p.m. at East Asheville Library at 3 Avon Road in Asheville.
Pisgah Legal Services is also helping people sign up for Medicaid for free. Learn more at pisgahlegal.org/ medicaid-expansion or call 828-210-3404.
Mitchell Black covers Buncombe County and health care for the Citizen Times. Email him at mblack@citizentimes.com or follow him on Twitter @MitchABlack. Please help support local journalism with a subscription to the Citizen Times.