Medicaid expansion enrollment begins marathon approach for state health secretary

Kinsley said in an interview with the Winston-Salem Journal and News & Record that he is trying to get the word out that Medicaid expansion is expected to bring coverage to more than 600,000 additional North Carolinians.

“We’re working to make sure with massive outreach efforts for months because this is a marathon, and not a sprint,” Kinsley said.

Health care services include:

• primary care;
• inpatient and outpatient hospital care;
• maternity and postpartum;
• vision and hearing;
• prescription drug benefits;
• behavioral health;
• preventive and wellness; and
• medical equipment, devices and therapies.

“I’m confident we’ll see busy waiting rooms across the state because of pent-up demand from working North Carolinians and their families,” Kinsley said.

About 270,000 of a potential 300,000 have been automatically enrolled through their participation in the state Medicaid’s limited Family Planning program. The N.C. Department of Health and Human Services can begin accepting Medicaid expansion applications Friday from eligible North Carolinians who are between ages 19 and 64.

For more information about the expanded eligibility, go to https://medicaid.ncdhhs.gov/, county Department of Social Services or through community support initiatives.

According to state health officials, expansion would provide medical coverage to people making under about $20,120 a year.

Likewise, a family of three earning under about $34,000 would be eligible, as well as a family of six earning under $55,586.

“Without question, rural North Carolinians will be the biggest benefactors of expansion,” Kinsley said. “They are three to four times more likely to be uninsured. Many are employed, either earning too much to currently qualify for Medicaid before now, or not enough to pay for health insurance coverage on their own.”

Getting word out

Kinsley said part of getting the word out about Medicaid expansion enrollment is informing eligible North Carolinians that it’s not a one-time-only enrollment period.

Instead, potential enrollees will be made eligible backdated to the first day of the month in which they apply.

“We’ll see a lot of folks coming forward in the first weeks of December to apply,” Kinsley said. “We expect to see a deluge, which could put off completing the processing of some applications into January or February because of the expected backlog.

“In those cases, the effective starting date will still be Dec. 1.”

Friday’s enrollment rollout also provides a safety net for some North Carolinians who still may be ineligible for Medicaid expansion, but learn during the application process that they can obtain coverage through the federal health insurance exchange, Kinsley said.

Kinsley expressed concern that there still may be eligible North Carolinians who fall through the cracks because they aren’t notified.

He compared his worry to when the high demand for initial COVID-19 vaccines faded over time and supply began to exceed demand, particularly for boosters.

“What saved the most lives was continuing to track down individuals to get the vaccine when things inverted with supply and demand,” Kinsley said. “We had to take the vaccine to where people are to make this live-saving tool available.”

Kinsley said that’s why tracking eligible North Carolinians after the initial enrollment push is a priority.

“When the dust settles (on enrollment) and people lose interest and aren’t talking about it, there’s still going to be 20,000 to 40,000 people in N.C. that will be eligible, in historically marginalized populations, living in rural communities, working two to three jobs,” Kinsley said. “People who are in the sandwich generation, taking care of mom and dad and taking care of their kids. Their lives are so busy and so hard.

“We have to be persistent and be just as focused in the spring and summer as we are right now so we can sign up as many people as possible.”

Law enforcement component

Kinsley praised rural county commissioners and law-enforcement officers for realizing the value of Medicaid expansion.

That was in particular for individuals who initially received behavioral health or opioid-addiction treatment while in jail, only to have it end after they are released because of lack of health insurance coverage.

“The lack of Medicaid expansion has served as an unfunded mandate on county governments,” Kinsley said.

“Medicaid expansion is the right bridge for that population — able-bodied, work-eligible individuals — to sustain their treatment, with employment supports that can lead to sustainable employment, hopefully with health insurance included.”

Kinsley said DHHS has had “sheriffs and law enforcement step forward to say ‘we’re not going to be able to arrest our way out of these problems.’”

“About 60% of people in incarcerated settings have a substance-abuse disorder, and many have a concrete mental-health issue.”

“While we were excited for the opioid settlement dollars, it’s a drop in the bucket when you think about the cost of actually sustaining care,” Kinsley said. “You can’t start a treatment program” with the opioid settlement dollars in rural counties.”

Financial considerations

Expanding Medicaid has been a top priority for Democratic Gov. Roy Cooper, who signed the bipartisan Medicaid expansion bill that made North Carolina the 41st Medicaid expansion state.

Family Planning Medicaid provides reproductive health care at no cost to people with incomes up to 195% of the federal poverty line — an income of about $2,370 a month for a single person.

However, not everyone with limited Family Planning Program benefits will be automatically enrolled in full Medicaid coverage.

Some people may have income that exceeds the new Medicaid eligibility levels, even though qualifying income levels are higher than the past.

For individuals whose income has recently changed and they think they may be eligible, they are asked to update their information in ePASS or by contacting their local DSS.

Those who are eligible for full Medicaid benefits will be assigned a health plan and receive a packet from their health plan in the mail that includes a new Medicaid ID card.

Additionally, anyone with health coverage through HealthCare.gov will need to cancel their plan once they are enrolled in NC Medicaid.

Cost of delay

Kinsley cited that North Carolina lost about $3.2 billion in federal Medicaid expansion funding, or about $400 million monthly, “that’s gone forever” because of the delay between March 27 and Friday.

That $400 million in monthly funding becomes available now.

Even as Kinsley expressed gratitude for expansion, he also lamented the loss of life among the eligible Medicaid population since Cooper signed the bipartisan expansion language into law on March 27.

However, because Medicaid expansion startup funding was contained in the 2023-24 state budget bill, months of budget negotiations between House and Senate Republican leadership stalled the rollout until Cooper allowed the controversial bill to become law on Sept. 25.

A national study on Medicaid expansion by the Center on Budget and Policy Priorities released in November 2019 found that at least 1,400 North Carolinians may have died between 2014 and 2017 because the state has not expanded coverage.

Researchers also found decreases in: individuals not taking prescription medicine due to cost; one-year mortality for patients diagnosed with end-stage renal disease; individuals screening positive for depression; and individuals lacking a primary physician or outlet for care.

“This new evidence, that thousands of lives are at stake, should give states that have not yet expanded Medicaid one more reason to do so,” Center on Budget and Policy Priorities researchers said. “It should also finally put to rest claims that Medicaid doesn’t provide quality coverage.”

Kinsley said that fatality total likely became larger in North Carolina during the COVID-19 pandemic because the virus disproportionately affected those lacking health insurance.

“The number of people who became chronically ill or died because they didn’t have access to preventive care services and tools is always on my mind,” Kinsley said.

“How many lives could have been saved if those individuals, particular in rural communities, had access to preventive and personal health care?” Kinsley asked.

“How many rural hospitals could have stayed in business rather than go out of business?”