This story was originally published by North Carolina Health News, story by Jaymie Baxley
Medicaid expansion finally launched Friday in North Carolina, giving an estimated 600,000 low-income residents across the state access to health insurance.
Here are answers to some questions you may have about expansion and what it means for the state.
Who is now eligible for Medicaid in North Carolina?
People ages 19 to 64 whose incomes are within 138 percent of the federal poverty level for their household size.
That means a single adult living in a one-person household is eligible if their annual income is $20,120 or less before taxes. It also means many of these single adults are eligible for coverage under the program, something they were not eligible for in the past. The income limit increases by $7,094 for each additional household member, allowing a person with a family of four to make up to $41,400 a year and still receive coverage.
Does that include non-U.S. citizens?
Yes, if they’re in the state legally and have held “qualified” immigration status for at least five years.
The five-year waiting period does not apply to “refugees, asylees or lawful permanent residents who used to be refugees or asylees,” according to the N.C. Department of Health and Human Services, making them immediately eligible under expansion.
What about undocumented residents?
In most cases, people who are in the U.S. who are undocumented are not eligible for benefits.
DHHS says an exception could be made if a person is suffering from an “emergency condition as defined under federal law.” The agency said an undocumented person who is taken to the emergency room after a car accident may be eligible for coverage, for example.
I’ve heard that some people are losing Medicaid even though their income is below the new limit. What’s that about?
A federal provision that prevented states from kicking Medicaid participants off the rolls during the first three years of the COVID-19 pandemic expired in April, allowing North Carolina to resume regular eligibility checks for the first time since March 2020.
From June to October of this year, more than 20,000 North Carolinians were deemed ineligible for Medicaid based on the state’s pre-expansion income limits. Many of these people are expected to regain eligibility under the new guidelines created by expansion, but they will need to go through the sign-up process again.
Is the state prioritizing certain groups for expansion?
Yes. About 300,000 people currently participating in Family Planning Medicaid, a limited-coverage program for reproductive health services, will be automatically upgraded to full coverage. These people are younger adults of reproductive age.
And everyone else?
If a person is approved for Medicaid, when will their coverage start?
Medicaid generally takes about 45 days to kick in, but its benefits can be applied retroactively. So, if someone goes to the hospital on Dec. 2, but they don’t receive a Medicaid card until mid-January, the hospital can bill the state for their care.
In a recent interview with NC Health News, Kody Kinsley, head of DHHS, said Medicaid will pay for health care expenses dating back to the first day of the month that a person applied for coverage.
“Your doctor is going to be able to bill us, and that’ll all be taken care of,” he said.
What services are covered by Medicaid?
Medicaid can be used for many of the same services covered by traditional health insurance, including doctor visits, routine check-ups and prescription drugs. The program also covers:
• Some vision, hearing and dental services.
• Emergency care and hospitalization.
• Maturity and postpartum care.
• Behavioral health treatment.
• Preventive health and wellness services.
Is there a monthly fee for Medicaid?
No, but DHHS says participants may occasionally have to pay $4 for services that require a co-payment.
What does expansion mean for people who are already on Medicaid?
The more than 2.8 million North Carolinians currently enrolled in Medicaid will continue to receive benefits the same way they did before expansion launched. No additional action is needed on their end.
Who is paying for Medicaid expansion?
The federal government is shouldering 90 percent of the cost. The remaining 10 percent will be paid by a new tax on the state’s hospitals.
Most states have already expanded the eligibility requirements for Medicaid. What took North Carolina so long?
Health care advocates began pushing the state 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 this year of more than $1.6 billion in federal financial incentives prompted the state’s GOP leadership to reconsider, and legislation making North Carolina the 40th state to expand Medicaid passed in March with bipartisan support.
If expansion was signed into law in March, why is it only now being implemented?
What options are available for uninsured residents who remain ineligible for Medicaid?
They may qualify for a low-cost health insurance plan through the Affordable Care Act.
Open enrollment for ACA plans is underway on the federal Marketplace. People with questions about the process can contact the N.C. Navigator Consortium, a federally funded organization that offers free consultation and support to insurance seekers.
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