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Medicaid expansion remains delayed, leaving thousands of North Carolinians uninsured


The North Carolina Department of Health and Human Services Dorothea Dix campus, located in Raleigh, is pictured on Aug. 26, 2022.

The N.C. Department of Health and Human Services announced on Aug. 28 that Medicaid expansion will not go into effect on Oct. 1, as previously planned.

Once Medicaid expansion goes into effect, hundreds of thousands of people across North Carolina will receive coverage, according to the NCDHHS. Medicaid expansion is a provision under the Affordable Care Act that has increased insurance coverage for low-income Americans since 2014.

Expansion was delayed because the N.C. General Assembly failed to pass the state budget or separate legislation that would authorize coverage. North Carolina is one of 11 states that have not yet expanded Medicaid.

The General Assembly coupled Medicaid expansion with the enactment of the state budget — which was initially planned to pass by June 30, according to Kody Kinsley, the secretary of the NCDHHS.

Kinsley said during a media briefing that Medicaid expansion cannot go into effect without the passing of a state budget, or separate legislation de-coupling the two decisions. De-coupling Medicaid expansion from the budget means passing the expansion on its own, apart from the approval of a budget.

In order to go into effect, Medicaid expansion must go into effect on the first day of a month, Nicole Dozier, the director of the Health Advocacy Project for the N.C. Justice Center, said. She also said the U.S. Centers for Medicare & Medicaid Services is allowing Medicaid expansion in North Carolina to take effect 30 days after the budget is passed.

Since the budget was not passed by Sept. 1, the expansion could not go into effect on Oct. 1.

Penny Wingard was laid off this May from her job as a school-based coordinator in Charlotte. She is one of the many North Carolinians in the Medicaid coverage gap.

Wingard said she would have been covered under Medicaid expansion, had the budget passed before Sept. 1. She also said she even saw Gov. Roy Cooper sign Medicaid expansion into law in March — and there was real hope it would go into effect quickly.

“I’ve gone through breast cancer, I lost my vision, I was diagnosed with an aneurysm that I can't get checked because I don't have any insurance,” Wingard said.

Wingard, who has previously shared her story to advocate for those who lack coverage, said she would like to start writing again about her experience of being uninsured.

Arrianna Marie Planey, an assistant professor in the Department of Health Policy and Management in the Gillings School of Global Public Health said in an email that Medicaid expansion has been a controversial — and even partisan — issue in the South, including in North Carolina.

“The budget has consistently been a sticking point in North Carolina politics, and the additional factor of Medicaid expansion and its implementation is a veritable bargaining chip,” she said.

Kinsley said in the media briefing that in addition to the thousands of people who would have been eligible for coverage on day one, Medicaid expansion also would have helped the North Carolinians who lose coverage each month due to the COVID-19 public health emergency unwinding.

“Approximately 600,000 people would become eligible for Medicaid at the same time that over 300,000 are likely to lose their Medicaid coverage through the 'unwinding' process,” Planey said.

According to the NCDHHS, the federal COVID-19 public health emergency provided Medicaid beneficiaries in the state with ongoing health coverage. As of April 1, states are no longer required to maintain continuous coverage.

Planey said that North Carolina is in the midst of a Medicaid transition, partially because of the end of the federal public health emergency.

Kinsley said in the briefing that depending on how soon the NCDHHS is given permission to move forward, the earliest Medicaid expansion could launch now is Dec. 1.

Dozier said the Health Advocacy Project has worked with those in the state who are losing coverage and are unable to get insured until expansion goes into effect.

“I do believe that we should be doing universal care, that every single person who is born in this country, this state, gets care and we just haven’t made that commitment to people,” Dozier said.

Wingard said North Carolina needs Medicaid expansion because many people can’t stay healthy due to an inability to afford medical visits. She also said that it is difficult to be in the coverage gap — especially for those who are unemployed. 

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“We consume a lot of debt, just to fight to live,” she said.


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