North Carolina: Medicaid enrollment up 18.6% since COVID hit; 373K - 500K would gain coverage via expansion

North Carolina

I've once again relaunched my project from last fall to track Medicaid enrollment (both standard and expansion alike) on a monthly basis for every state dating back to the ACA being signed into law.

For the various enrollment data, I'm using data from Medicaid.gov's Medicaid Enrollment Data Collected Through MBES reports. Unfortunately, they've only published enrollment data through December 2020. In most states I've been able to get more recent enrollment data from state websites and other sources. For 2021 North Carolina data, I'm using estimates based on raw data from the North Carolina Dept. of Health & Human Services.

North Carolina is one of 12 states which still hasn't expanded Medicaid eligibility under the ACA (13 if you include Missouri, whose voters expanded the program last year...but which the state legislature refuses to fund).

North Carolina's non-ACA Medicaid enrollment gradually rose from ~1.8 million to ~2.1 million from 2014 - 2020...but since the COVID pandemic hit in early 2020, it's increased a good 18.6%.

In addition, according to the Kaiser Family Foundation, there's 373,000 uninsured North Carolina residents who would become newly eligible if the state were to expand Medicaid under the ACA, including 212,000 currently caught in the "Medicaid Gap" (those who earn less than 100% of the Federal Poverty Level, thus disqualifying them for ACA exchange subsidies either) and another 161,000 uninsured who qualify for a subsidized private healthcare policy but who haven't enrolled in one so far.

This article makes it sound like the total could be more like 500,000, however. Part of the discrepancy may be the roughly 176,000 NC residents who earn 100 - 138% FPL who are already enrolled in heavily-subsidized ACA exchange plans; they'd be shifted over to Medicaid instead if the state expanded the program.

In addition, KFF estimates around 32,000 uninsured NC residents who are already eligible for the program but who haven't signed up as of yet.

North Carolina has just over 10.4 million residents according to the 2020 U.S. Census. As of June 2021, around 2.55 million of them were enrolled in Medicaid, or 24.4% of the state population.