By Jaymie Baxley
When North Carolina launched Medicaid expansion on Dec. 1, state officials said the measure would provide health insurance to an estimated 600,000 low-income adults over a span of two years.
It took just two months to reach 58 percent of that goal. More than 346,400 newly eligible beneficiaries have been approved for coverage as of Feb. 1, according to data from the N.C. Department of Health and Human Services.
The fast pace of enrollment was one of several expansion-related success stories that DHHS leaders shared with lawmakers during last week’s meeting of the monthly Joint Legislative Oversight Committee on Medicaid. It was the first formal report the department had presented to the 14-person committee since expansion took effect.
Expansion raised the state’s income limit for Medicaid, extending eligibility to people who make an annual income of up to 138 percent of the federal poverty level based on their household size ($25,820 for a family of three). The previous limit was 100 percent.
Jay Ludlam, the state’s deputy secretary for Medicaid, told the committee that DHHS launched expansion “in a way that was member-focused.” About 273,000 adults who had been enrolled in Family Planning Medicaid, a limited-coverage program for reproductive health services, were automatically upgraded to full Medicaid coverage when expansion went live in December.
“We ran the algorithm on the information that we had for that population,” Ludlam said. “We determined those individuals who would qualify for Medicaid expansion and those who wouldn’t, and we moved those individuals who [did] qualify onto expansion.”
That strategy, he said, allowed the department to hit the ground running. Most of the new beneficiaries gained Medicaid with little or no action needed on their end.
“Those individuals didn’t have to go into an office,” Ludlam said. “They didn’t have to call a DSS worker. They didn’t have to fill out a form. Effectively, they woke up on December 1st with a card in hand, and they were able to access the full Medicaid benefit on Day One.”
People who were not part of the initial wave of automatic enrollments have been signing up for Medicaid at a steady clip since expansion launched. Ludlam said DHHS is adding an average of 1,000 beneficiaries to the rolls each day — a number he believes will taper off in the coming weeks.
A disproportionate share of the state’s new enrollees are residents of rural, economically distressed counties. That isn’t entirely surprising, according to Ludlam. He said expansion was expected to have an outsize impact in rural areas.
“Broadly, in some of these communities, we would have anticipated high enrollment,” he said. “These are areas where individuals are working potentially more than one job to make ends meet.”
‘Knocking on death’s door’
For people like DeAnna Brandon, the value of Medicaid can be measured in days rather than dollars.
Diagnosed with a rare blood cancer in 2022, the Rowan County resident was told she had less than three years to live unless she received a stem cell transplant. Brandon, whose story was first reported by NC Health News, couldn’t afford the expensive procedure without health insurance — and her biological window of opportunity was growing smaller.
The chemotherapy that helped Brandon manage the symptoms of her cancer threatened to cause irreversible damage to her cells, undermining the effectiveness of the transplant. The physical toll of the treatment also left her unable to work.
Brandon had assumed that her predicament made her eligible for Medicaid. The cancer, after all, was technically a disability that prevented her from earning a steady income. But when she applied for coverage last year before expansion went into effect, she was told her condition did not satisfy the state’s eligibility requirements.
She became hopeful when Gov. Roy Cooper signed expansion into law last March. The new income threshold meant Brandon would qualify for Medicaid irrespective of her ability to work.
Her hope turned to frustration after the implementation of expansion was delayed by the General Assembly’s protracted dispute over a state budget. Lawmakers eventually agreed to move forward with a spending plan in September, allowing expansion to go live — albeit months behind schedule — in December.
By that time, Brandon had successfully appealed the state’s decision to reject her application for Medicaid. She was approved for coverage shortly before expansion took effect.
On Tuesday, she completed the first of two procedures to harvest stem cells from her blood at Novant Health Presbyterian Medical Center in Charlotte. The cells will be transplanted back into her body on March 1.
Brandon said her immune system will be “totally wiped out” after the surgery, forcing her to isolate at home for three months.
“I can’t go anywhere but to doctor’s appointments, and no one can come and see me except for one, sole caregiver,” she said. “I’ll be like a newborn baby. Over the course of the next two years, I’ll have to get all of my childhood immunizations again.”
Still, Brandon believes the ordeal is a small price to pay for more time with her loved ones. The transplant is expected to extend her life by about 10 years.
“I don’t want to say I was knocking on death’s door without Medicaid, but that’s what the doctors told me,” she said. “Ten years might not sound like a lot of time to a lot of people, but 10 years sounds great when you’re faced with just three.”
Could N.C. be a bellwether?
Lawmakers in Florida, one of 10 states that have yet to expand Medicaid, may now be looking to North Carolina as a model.
Sen. Kevin Corbin, a Macon County Republican who serves on the oversight committee, traveled to Tallahassee this week to discuss North Carolina’s experience with members of the Florida legislature. The meeting went “extremely well,” according to Corbin.
“Their new leadership’s getting ready to come in next year after the election, so I don’t think anybody’s willing to say they’re gonna do this or do that just yet,” he said in a phone interview on Wednesday. “But I think they’re definitely encouraged about what I’ve told them, and I think they’re willing to take a look at what we did in North Carolina.”
Health care advocates began pushing North Carolina to expand access to Medicaid after the Affordable Care Act was implemented in 2012, but their efforts were repeatedly thwarted by Republicans in the General Assembly. The promise last year of more than $1.6 billion in federal financial incentives prompted the state’s GOP leadership to reconsider, allowing expansion to pass with bipartisan support.
A longtime insurance agent, Corbin said Medicaid is “cheaper than private insurance or Medicare” for North Carolina. While the cost of running the program for the state’s nearly 3 million participants is roughly $21 billon, the vast majority of the bill is picked up by the federal government and hospitals.
The state, Corbin said, pays “scarcely over 100 bucks a month per member.”
While expansion means more North Carolinians on Medicaid, the state’s financial burden will be lower because of the federal incentives. Mark Collins, a fiscal analyst for the N.C. General Assembly, told the oversight committee that the state’s overall share of the program’s cost is expected to decrease by nearly 15 percent.
Republish our articles for free, online or in print, under a Creative Commons license.
