North Carolina: Oh yeah...up to 600,000 more people gained comprehensive healthcare coverage today thanks to the #ACA

Back in March, after years of failed and stalled attempts to get it passed, the North Carolina legislature finally pushed ACA Medicaid expansion over the line to be signed into law by Democratic Governor Roy Cooper.

Today, it became a reality:

Nearly 600,000 North Carolinians Now Have Access to Medicaid Expansion Coverage

• North Carolina becomes the fourth state to expand Medicaid during the Biden-Harris Administration

The U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), celebrated the news that approximately 600,000 North Carolinians between the ages of 19-64 are now eligible for comprehensive health coverage, thanks to the Affordable Care Act’s (ACA) Medicaid expansion. Starting today, these individuals will have access to all the benefits they need to stay healthy and be well, such as primary and preventive care, mental health and substance use disorder treatment, emergency care, and access to prescription drugs. Since the start of the Biden-Harris Administration, three states in addition to North Carolina have expanded Medicaid: Missouri, Oklahoma, and South Dakota.

According to the North Carolina DHHS, around half the total eligible (~300,000) are being automatically enrolled. The other ~300K can enroll via traditional means via the state's ePASS website or in person at their local Dept. of Social Services office.

It's also worth noting that around ~260,000 or so of those gaining Medicaid eligibility are actually currently enrolled in ACA exchange plans (289,080 NC enrollees during the 2023 Open Enrollment Period earned less than 138% of the Federal Poverty Level; I'm assuming perhaps 90% of that population were still enrolled in ACA plans as of yesterday). I'm not sure how much overlap there is between this population and the ~300K who are being auto-enrolled, however.

This does mean, as I've noted before, that North Carolina's official ACA Open Enrollment Period tally will likely drop significantly from last years's total of 800,850...although some of this will be made up for by new enrollees who earn more than 138% FPL and, ironically, a chunk of those who lost Medicaid coverage over the summer/fall via the Unwinding process (around 30K NC residents had moved to ACA plans as of August).

“Today is a victory for the 600,000 North Carolinians who have been waiting for health coverage,” said HHS Secretary Xavier Becerra. “Medicaid is a lifeline and ensuring everyone who qualifies for it can access it remains a priority for the Biden-Harris Administration. Every American deserves quality, affordable health care and the peace of mind that comes with knowing one unexpected doctor’s visit won’t throw their life into financial chaos. I want to congratulate North Carolina on joining the ranks of states that are bringing quality health coverage to our neighbors and families. I encourage the remaining 10 states to join us, so that every eligible person can get covered.”

"Medicaid Expansion is the working families bill of the decade for North Carolina, and its impact on peoples' health, combating the opioid crisis, saving rural hospitals and boosting our economy will be life-changing for families in our state,” said Governor Roy Cooper. “I am particularly grateful for the federal signing bonus that President Biden signed into law that was a major part of our successful effort to finally expand Medicaid. I encourage anyone who thinks they might qualify to visit medicaid.nc.gov to learn more."

“This is a critical milestone for so many people in North Carolina who until now have faced unnecessary barriers to health care,” said CMS Administrator Chiquita Brooks-LaSure. “Expanding Medicaid is a major step forward towards equity in health for all North Carolinians, especially those in underserved communities, as well as helping to support hospitals across the state. It’s crucial that the ten remaining states expand their Medicaid programs so that the millions of people in the coverage gap today can receive the essential health care they need.”

In implementing its Medicaid expansion, North Carolina will be able to offer nearly all adults aged 19 to 64 who make less than $20,120 annually comprehensive health coverage through Medicaid.

HHS strongly urges the 10 remaining states – Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin, and Wyoming – to expand Medicaid and deliver essential health care coverage for their residents. If all remaining states were to expand their Medicaid programs under the ACA, as many as 3.5 million more un- or under-insured individuals could enroll in high-quality, affordable health care coverage through Medicaid. Medicaid expansion in these states would have an outsized impact in communities of color, with three in five people who would gain eligibility coming from the Black or Hispanic communities.

In addition to becoming the 40th state, along with D.C., to adopt the ACA’s Medicaid expansion, North Carolina projects it will receive almost $1.8 billion in additional federal funding thanks to President Biden’s American Rescue Plan (ARP).

Medicaid, together with the Children’s Health Insurance Program (CHIP), remains the largest source of health care coverage in the U.S., connecting nearly 90 million individuals to a range of critical health services.