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'If I just had Medicaid, I wouldn't have to worry:' Students prepare for December Medicaid expansion


The N.C. General Assembly sits in Raleigh.

At Daira Hernandez-Gayosso’s 18th birthday party, she received a text from CVS Pharmacy that her medical insurance would not cover the cost of her medication. In a panic, she said she called the health department and learned that she no longer qualified for traditional Medicaid because of her age.

“I was very sad and mostly worried,” Gayosso, a UNC sophomore, said. “It consumed my mind a lot. And I remember it was near finals. I just wanted to cry.”

That was last December. Now, Gayosso said she feels some sense of relief because Medicaid in North Carolina will expand under the Affordable Care Act beginning Dec. 1.  

Medicaid is a health insurance program for low-income individuals and families, which covers health services like hospital visits, prescriptions, vision care and dental care. The new age requirement for adults earning up to 138% of the federal poverty line is 19 to 64 years old. In North Carolina, the requirement previously cut off at 18 years old. 

Ciara Zachary, a UNC assistant professor in the Department of Health Policy and Management, said she wishes the expansion could have happened sooner. One of the reasons the policy has taken over a decade to go into effect, she said, is because it was tied to the state budget and people had to vote on how to allocate funds. 

"This is when the policy is difficult, sometimes to get one great policy when you take some losses,” Zachary said

Gayosso said losing her Medicaid had an impact on her mental health and affected her everyday life. She said she didn’t feel like herself and struggled to focus on her academics. 

She said was taking three medications for mental health — two antidepressants and one antipsychotic — but Gayosso had to go weeks without taking them because she could not afford her medication. 

“I was feeling symptoms of withdrawal,” she said. “I would just walk and I would feel very dizzy. The light would bother my eyes. Like, a throbbing head [pain], it was really bad.”

Gayosso said her mental condition not only worsened because of a prior mental health diagnosis, but also because she had to constantly worry about having access to a doctor.

In a February message from Chancellor Kevin Guskiewicz titled "Facing the Mental Health Challenge", he addressed his actions towards improving mental health on campus.

“Rates of anxiety and depression have been rising not just among college students, but among young Americans of all backgrounds,” Guskiewicz wrote

However, like Gayosso, not all low-income students can afford therapy sessions or medication. According to the Office of Institutional Research and Assessment, UNC enrolled 3,508 low-income students in the fall of 2021. Media Relations said in an email statement that 603 students use North Carolina Medicaid to meet the University’s health insurance requirements. 

Campus Health is a North Carolina Medicaid participating provider, which allows students to access Campus Health and Counseling and Psychological Services. Starting Dec 1., more students will have access to CAPS without having to afford the copay.

Abby Emanuelson, the executive director of Care4Carolina, a coalition of nearly 200 organizations advocating for Medicaid expansion, said that to improve behavioral health among college students, lawmakers must start by closing the health insurance coverage gap.

“Among disadvantaged college students with mental health conditions, Medicaid expansion was associated with increased coverage rates and a greater likelihood of being diagnosed with a mental health condition, and of using prescription medications for a mental health condition,” Emanuelson said.

Zachary said worrying about health can impact some student’s academic performance and attaining a job,

“It's like, am I able to afford to take the day off? Or do I need to put gas in my car? Do I need to put food on my table? You know, can I afford to get these prescription medications? And so I think the relief people will feel once they know that they have coverage will be tremendous,” she said

While she is hopeful about medicaid expansion, Gayosso said she still has some worries about whether she’ll actually receive aid. She said she hopes to return to not having to worry about the costs of being healthy. 

“I feel like if I just had Medicaid, I wouldn't have to worry about constantly renewing stuff in different areas, like the mental health clinic, or at the doctor,” she said.


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