Medicaid Expansion Enrollment Opens in North Carolina

On December 1, North Carolina became the latest state to expand Medicaid under the Affordable Care Act, meaning approximately 600,000 residents now have access to comprehensive health coverage. The North Carolina Department of Health and Human Services is now providing links and information on how to quickly apply for coverage either online, over the phone, or in person – including how to get application help if needed – and there is a corresponding increase in news coverage on the expansion across the state. In addition, the state has automatically enrolled over 300,000 North Carolinians already in expanded Medicaid coverage – these are mostly folks already receiving limited Medicaid benefits and thus state databases showed these individuals were immediately qualified for expansion coverage.

Enrollment of those not automatically shifted to expansion coverage is being led by multiple organizations around the state, including the NC Justice Center, Legal Aid of NC, NC Child, providers like Cone Health, the NC Navigator consortium, Care4Carolina, local county DHHS departments, and many other groups working with the NC DHHS to provide as many people as possible the information about how to enroll and the new coverage. There are multiple events scheduled all around NC. Community and philanthropic organizations will continue to lead the primary outreach efforts for enrolling people in expansion as the state moves forward.

Virginia’s Medicaid expansion began enrolling people in 2019 and within a year had resulted in a significant improvement in the rate of insurance for lower-income adults along with an increase in visits for necessary medical care and increased financial security for enrollees.  Need for health coverage – which for many people had been unavailable before expansion – drove enrollment in the state. Virginia’s southern neighbor state can likely expect similar outcomes.

Remaining non-expansion states like Georgia, South Carolina, Alabama and Wyoming are all no doubt watching North Carolina closely to see how the state’s legislatively-passed Medicaid expansion works in practice. Georgia House Republicans convened a recent hearing on full Medicaid expansion and are hearing about North Carolina’s experience in coupling expansion with other health care reforms.  Georgia’s attempt to provide a very limited form of state-only expanded Medicaid coverage coupled with complicated work reporting requirements has resulted in only approximately 1,800 people getting coverage after months of operation in contrast to the 300,000 enrolled on NC’s first day of full expansion. This difference is no doubt driving some of the Georgia discussion.

As a public interest attorney and health advocate in North Carolina for many years, some of the hardest conversations I have ever had were with hardworking adults who needed important medical care but had no way to pay the bills. While I could try and help people by directing them to a patchwork of charitable care programs, these solutions were rarely adequate to provide comprehensive health care. Medicaid expansion in North Carolina will profoundly improve the lives of many North Carolinians.

Adam Searing is an Associate Professor at the Georgetown University McCourt School of Public Policy’s Center for Children and Families.