This story was first published by Jaymie Baxley, North Carolina Health News
January 23, 2024

Lori Kelley was decorating her Concord home for Christmas when she pierced her finger on a shard of glass from a broken ornament.

It seemed like a minor injury at first. Kelley wasn’t in pain, and the glass hadn’t cut deeply enough to draw blood. “I totally ignored it,” she said. 

Two days later, she was hospitalized with a “horrible” bacterial infection that required surgery. Her procedure was covered thanks to Medicaid expansion.

The long-awaited measure officially took effect on Dec. 1, making hundreds of thousands of low-income North Carolinians eligible for Medicaid. Kelley, who had been without health insurance since 2008, was among the first wave of people to enroll.

“It was great timing,” she said. “Had it not been for the expansion of Medicaid, I’d probably be a little over $100,000 in debt right now.”

Expansion raised the state’s income limit for the government-funded program, extending coverage to adults who make up to 138 percent of the federal poverty level based on their household size. The previous limit was 100 percent. 

More than 314,000 people gained access to Medicaid during the first 43 days of expansion, according to data released Monday by the N.C. Department of Health and Human Services. About 273,000 of those beneficiaries had been enrolled in Family Planning Medicaid, a limited-coverage program for reproductive health services, and were automatically upgraded to full Medicaid coverage when expansion went live. 

Since then, an additional 41,000 have signed up for coverage independently. DHHS said a large share of these enrollments came from rural counties. The influx has caused the state’s total Medicaid population to surpass 3 million.

Early impact

“We can already see the important impact expansion has on improving the health and lives of North Carolinians,” Sec. Kody Kinsley, head of DHHS, said in a statement on Monday. “They are our neighbors, child care specialists, construction workers, veterans, loved ones struggling with behavioral health challenges or substance use, and so many others.”

The sentiment was echoed by Kelley, who lives with a degenerative eye condition and other health issues. 

“I know what I’ve gone through, trying to manage my medical care on my own and not being able to afford copays and not being able to afford prescriptions,” she said. “So I know how much this means to other families and other people who have other long-term and underlying conditions that have gone unaddressed.”

In an interview, Kinsley pointed out that expansion has already covered $2.4 million in claims for dental services. More than 150,000 prescriptions have been filled through the measure, he said, with most of the medicines going to people with asthma, epilepsy and blood disorders.

“These are things that people really needed badly, and they’re getting [them] really fast,” he said. 

Combating stigma 

Not everyone is as convinced of the measure’s greatness.

Since expansion launched, health insurance “navigators” with the Charlotte Center for Legal Advocacy have been assisting newly eligible residents with the state’s online application process for Medicaid. Cassidy Estes-Rogers, a senior attorney and program director for the center, said the navigators have observed  “stigma and misinformation” surrounding Medicaid. 

“It’s a big change for North Carolina, and there’s still a lot of education to be done for the public,” she said in a recent interview with NC Health News. “We want to combat the idea that Medicaid isn’t good health coverage or that you get substandard care.”

According to Estes-Rogers, some people fear that their current primary care provider will no longer see them or treat them as less of a priority if they sign up for the program. 

These concerns are “mostly unfounded,” she said.

“Most of our providers, especially in the metropolitan area, accept Medicaid,” she said. “There’s generally not a lot of people turning down Medicaid in the way that I think some people may [presume] that they do.”

For its part, DHHS has been enlisting faith leaders and civic organizations to help spread the word about expansion and the many services covered by Medicaid. Kinsley said the department is also in the process of launching a publicity campaign to “keep people coming forward and getting enrolled.”

“The people that I am most concerned about getting — that are probably going to take us the longest — are the folks that, frankly, need it the most,” he said. “They are the moms and the dads with multiple jobs [whose] schedules get shifted every other day.”

He added that DHHS is looking for ways to make the application process easier and faster for working parents.

“When they finally do have a moment to apply because we’ve reached them through their church or through their whatever, we need it to be as easy as possible,” he said. 

Enrolling at a fast clip

Kinsley said he’s proud that the rollout is moving along so quickly.

In the months leading up to expansion, health officials predicted that 600,000 people would be added to the state’s Medicaid rolls. That oft-touted figure was an estimate of how many beneficiaries would gain coverage over the next two years, according to Kinsley.

“I have not been able to find — and I’ve asked all the right people — any state that has been able to launch expansion and get beyond halfway of its expected goal by the first month,” he said. 

Kinsley explained that there were many people who were likely to be eligible who were about to be kicked off the rolls because of the “unwinding” that was taking place in the wake of the pandemic public health emergency. But the state’s Medicaid program was able to move hundreds of thousands of those people onto the family planning program to keep them eligible for that one slim benefit in the interim. Once expansion rolled out, it was easier to upgrade them to full coverage. 

“The fact that we had so many people known to us, as part of the public health emergency just allowed us to move all these people on really fast,” he said. 

NC Health News Editor Rose Hoban contributed reporting. 

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