RALEIGH, N.C. — Ten years after the federal government began offering expanded Medicaid coverage in states that chose to accept it, hundreds of thousands of adults in North Carolina will receive benefits, a development that boosters say will help hospitals and local economies in addition to the long-term crisis. term uninsured.
North Carolina elected officials agreed this year to expand Medicaid, which will offer government-funded health insurance to adults ages 19 to 64 who make too much money to receive traditional Medicaid but generally not enough to take advantage of government subsidies available for private health insurance. The federal government will pay 90% of the costs, as provided in the Affordable Care Act of 2010.
More than 600,000 North Carolinians are expected to eventually qualify, with about half of them automatically enrolled starting Friday. That means they can get annual checkups, prescription medications and other services with little or no out-of-pocket costs.
Residents, including Carrie McBane, have been navigating the divide for years between earning too much to qualify for Medicaid and too little to afford private insurance. She is hopeful that expanded eligibility will revive the state’s working class, especially in rural communities like her small mountain town of Sylva, located 300 miles west of Raleigh.
The 50-year-old had paid out of pocket to see several doctors who were unable to identify her debilitating disease, until someone finally diagnosed her with type 2 diabetes. By then, her organs were starting to fail and she could barely work enough hours as a restaurant server to pay for the insulin and her other new prescriptions. Her monthly income was still about $100 too high to qualify for Medicaid, she said.
“It’s the worst feeling in the world when you don’t know what’s happening to your body, but you know something is terribly wrong and you haven’t gotten any help from the medical industry,” McBane said. The bills are piling up.”
North Carolina’s decision to join the expanded Medicaid program makes it the 40th state to do so. The District of Columbia is also participating. Some states with Republican leaders have recently considered expansion after resisting it for years, largely because they feared federal policy would change and require states to pay a higher percentage of the costs. The ten remaining states not participating are largely Republican-controlled and concentrated in the South and Midwest.
Expansion should help reduce the percentage of adults under age 65 in North Carolina who are considered uninsured. A 2022 report from the National Center for Health Statistics estimated North Carolina’s uninsured population at 17.6%, significantly above the national average of 12.6%. The state currently has 2.9 million enrollees covered by some form of traditional Medicaid.
“This is a phenomenal moment for North Carolina and for the people of North Carolina,” Health and Human Services Secretary Kody Kinsley said in an interview. “All of that adds to the peace of mind of knowing that when they need health care, it won’t drive them into debt.”
Democratic Governor Roy Cooper had pushed hard for Medicaid expansion since taking office in early 2017. But Republican legislative leaders weren’t sold, saying they were leery about more government insurance and the chance that Congress would cut its funding.
They were excited about the idea in 2022, when the federal government offered a $1.8 billion bonus over two years if North Carolina signed up.
In March, the Republican-dominated General Assembly passed the legislation, and Cooper signed it into law. It stipulates that North Carolina hospitals will cover the state’s 10% share of costs through increased assessments that began in November, according to DHHS.
Participation in the Medicaid expansion and another federal program that North Carolina hospitals have entered into under the new law should bring $8 billion in federal funds into the state annually, according to state officials. The money should help reimburse rural hospitals that treat large numbers of uninsured people. It can also generate economic benefits through the healthcare system.
To qualify for Medicaid under the new guidelines, a single person can earn up to $20,120 in pre-tax income annually, while a household of four can earn up to $41,400 from which an adult can benefit.
McBane, who lives alone and has had no health insurance for almost 18 years, is now looking for a job that will allow her to take care of her health while staying within the income range that keeps her in the program.
Many of her neighbors work fast-food or construction jobs that don’t cover health care, and they face stress and stigma when they need to visit a doctor, she explained. Much of Western North Carolina falls into the Medicaid coverage gap, “and citizens are absolutely being left behind,” McBane said. She expects that expansion will not only ease the financial burden on her community, but that many low-income residents will also feel more welcome in exam rooms.
The state has added social workers and better technology to assess Medicaid eligibility for all enrollees now that a COVID-19 policy that bars states from kicking anyone off Medicaid has ended. DHHS also works with faith organizations, community groups and other trusted local voices to raise awareness of people newly eligible for federally funded care, Kinsley said.
‘They’re working. They take care of their children,” he said. “And so we’re going to have to meet them where they are and use every tool we have to help them connect to this important tool that they need for their health.”