North Carolina finally expanded Medicaid under the Affordable Care Act, with Gov. Roy Cooper (D) making it official with his signature Monday. It’s not going to go into effect until the legislature passes the budget, but it’s now the law in the state. “The strength of our communities depends on the health of our people,” Cooper said Monday at the bill signing. “Today is a historic step.”
“For the workers in our communities who perform some of our most essential tasks—caring for our children, tending to the sick and elderly, stocking our grocery shelves & staffing our restaurants—this law will bring so many the opportunity for better health and a better life,” Cooper added. “Hundreds of thousands of hardworking North Carolinians, many with 2 or more jobs, have suffered in the coverage gap while a solution sat just out of reach. With this, many of them will be close enough to grab it,” he continued. “This can mean no more dying from preventable or treatable illness.”
North Carolina is the 40th state to accept the expansion, and will bring more than 600,000 people who have been shut out of health insurance into coverage. There are about 3 million of the state’s citizens already enrolled in Medicaid. While this state is moving forward, all of the others are figuring out how to deal with the end of the pandemic regulations that dramatically expanded coverage across the nation.
RELATED: North Carolina about to become the 40th state to expand Medicaid
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As many as 17 million people could lose their Medicaid coverage at the beginning of April. For the past three years, states were barred from dropping people from their Medicaid rolls as a pandemic relief measure. That’s 17 million in the 40 states who have estimated the impact—11 states still haven’t reported data. Before the COVID-19 pandemic, Medicaid enrollees had to reapply for coverage annually under federal rules. Families also had to reapply for the Children’s Health Insurance Program annually.
The COVID-19 public health emergency will expire on May 11, 2023 and states have been given 12 months starting on Apr. 1 to “unwind” the pandemic expansion and return to normal enrollment operations, reverting back to normal eligibility requirements. That means if their income has increased or they’ve had a change in their disability status, they could lose coverage.
Kaiser Family Foundation and the Georgetown University Center for Children and Families asked states about their unwinding process in their annual survey of Medicaid and CHIP program officials in January. Most of the states are taking steps to try to minimize the fall-off by taking the file 12-14 months to work through re-enrollments; using an ex parte or administrative process where the state verifies ongoing eligibility by using existing data sources rather than putting the whole responsibility on the enrollee; taking extra steps to provide outreach to enrollees who could be dropping off; and providing information about the unwinding process on state websites.
It’s mostly the blue states that expanded Medicaid and that have worked to ensure maximum coverage for their populations during the pandemic that are working to keep people insured, whether on Medicaid or in other programs. Some, like Rhode Island, are automatically moving people who lose Medicaid eligibility into an Affordable Care Act plan. That state will pay for the first two months of premiums. Other blue states are enhancing the subsidies for marketplace plans.
About 20 million people gained coverage through Medicaid during the pandemic. It helped bring the uninsured rate to an all-time low in 2022. Over the next 12-14 months, that’s going to change. The states with the biggest uninsured populations before the pandemic—Texas and Florida—have refused to expand Medicaid and aren’t likely to go out of their way to make sure that the people who are losing coverage now find another option.
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