By Theresa Opeka
Carolina Journal
Sunday marked the one-year anniversary of Medicaid expansion in North Carolina.
It expanded government-funded coverage to North Carolinians earning up to $20,000 annually and families of four who earn up to $41,000 annually.
It also added hundreds of thousands of working-age, able-bodied adults to the state’s Medicaid program, which made it the largest single expansion of an entitlement program in state history.
About 600,000 North Carolinians were projected to be eligible for Medicaid once the bill became law.
It has been one of the top priorities for Democrat Gov. Roy Cooper who had been pushing for it for several years before the North Carolina General Assembly agreed to pass it in House Bill 76 in March 2023, provided that it was attached to the budget.
“This law, once implemented, will be the working families bill of the decade,” he said as he signed Medicaid expansion into law on March 27, 2023.
Shortly after the legislature passed the budget in September 2023, Cooper said he would let the bill become law without his signature, citing the importance of Medicaid expansion.
Republicans who changed their minds on the issue said at the time they did the right thing and that historic gains were made for healthcare competition in the state.
As he did in the past, Senate Leader Phil Berger, R- Rockingham, said in March 2023 that North Carolina had a broken Medicaid system, and there was no way it could have handled an influx of hundreds of thousands of new enrollees. He said transforming the program from a fee-for-service model to a managed care model provided better budget predictability and put more focus on the quality of care. But before they could give out more insurance cards, he said it was necessary to address the cost and availability of healthcare with Certificate of Need (CON) reforms.
CON laws require providers to demonstrate community need for a medical service before getting permission from the state to offer it.
Of the state’s 27 Certificate of Need laws, the expansion bill only repealed two on addiction and mental health beds and replacement equipment up to $3 million. It also repealed two CON laws for only the 23 largest counties two to three years after federal HASP payments to the hospitals begin.
Fifteen states have abandoned the regulations since the mandate was repealed in the 1980s. In those non-CON states, studies have shown that after repeal, prices go down and access to care goes up.
Of the 35 states that still have CON laws on the books, North Carolina’s 27 separate CON requirements make it the second-most CON-regulated state in the nation.
Berger said in March 2023 that the state’s provider shortage meant that Medicaid expansion won’t solve all of the problems, and additional supply-side reforms were needed to chip away at rules that prevent citizens from accessing healthcare.
House Speaker Tim Moore, R- Cleveland, said there is a significant shortage when it comes to behavioral health and that great strides will be made in that direction with the passage of the bill. He also said it would have a tremendous effect on rural healthcare.
Sadly, rural healthcare hasn’t gotten better.
According to the North Carolina Department of Health and Human Services Medicaid Expansion Dashboard, 577,107 North Carolinians were enrolled as of Nov. 13.
The dashboard provides a further breakdown of different categories, one of which is enrollment by age group. Those ages 19-29 had the highest enrollment numbers, with 199,870 or 35.1%. Each age group thereafter shows a graduated decline, with ages 60-64 having the lowest number, 38,761 or 6.8%.
Urban areas also show higher numbers, with 358,128 or 62.9%, compared to 210,953 or 37.1% for those in rural areas.
Brian Balfour, senior vice president of research at the John Locke Foundation, told the Carolina Journal that it will be very interesting to see if Medicaid expansion numbers continue to grow past 600,000 in 2025 and, if it does, how the government will cover the costs for additional enrollees.
“Medicaid now covers just over 3 million North Carolinians, meaning a little over one in four people in the state are dependent on this government program for their health insurance,” Balfour said. “With growing doctor shortages and fewer doctors accepting new Medicaid patients, one major question is: who will these Medicaid enrollees see when they get sick? The program was already overcrowded before expansion. Coverage does not mean access to care, and the concern is that enrollees are going to learn this very difficult lesson at the expense of their health.”
Theresa Opeka is the Executive Branch reporter for the Carolina Journal.
Well, what is their choice? Whether they can receive care or not, they still need coverage. More and more hospital ER’s are being used as a doctor’s office. Doctor’s would probably more readily accept Medicaid if it didn’t have so much red tape. I have also heard it stated that those with Medicaid fail to show for appointments. I can only speak to what I have heard from offices that don’t accept Medicaid.
However, I do know that braces are being offered without a medical need which hasn’t always been the case. I agree with regular dental care but braces for aesthetic purposes only is a waste of taxpayer dollars.
The 40K cut off is really low. How many people can afford to even have a place to live at 40K a year much less afford healthcare. Employer paid healthcare is either severely lacking, cost too much or both! You will be hard pressed to find a livable place for less than 1500 a month for a family of four. That leaves after tax about 700 a month for gas, electric and groceries.