Medicaid Expansion to Deliver Rapid Benefits

Written by Jamie Baxley

Lori Kelly was putting up Christmas decorations in her Concord home when she stabbed her finger with a piece of glass from a broken ornament.

At first, it seemed like the injury was minor. Kelly wasn't in any pain, and his glass wasn't cut deep enough to draw blood. “I completely ignored it,” she said.

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

The long-awaited measure officially went into effect on Dec. 1, making hundreds of thousands of low-income North Carolinians eligible for Medicaid. Kelly hadn't had health insurance since 2008, but was one of the first wave to do so.

“It was great timing,” she said. “If it hadn't been for Medicaid expansion, I probably would have been in debt by now, a little over $100,000.”

The expansion raised state income limits for federally funded programs and expanded eligibility to adults making up to 138 percent of the federal poverty level based on household size. The previous limit was 100%.

More than 314,000 people gained access to Medicaid in the first 43 days of the expansion, according to data released Monday by the North Carolina Department of Health and Human Services. Approximately 273,000 of these beneficiaries were enrolled in Planned Parenthood Medicaid, a limited coverage program for reproductive health services, and were automatically upgraded to full Medicaid coverage when the expansion began.

Since then, an additional 41,000 people have independently signed up for coverage. DHHS said the majority of these enrollees are from rural counties. This influx brings the state's total Medicaid population to more than 3 million people.

early influence

“We can already see that the expansion will have a significant impact on improving the health and lives of North Carolinians,” DHHS Director Cody Kinsley said in a statement Monday. “They are our neighbors, child care professionals, construction workers, veterans, loved ones struggling with behavioral health issues and substance use, and many others.”

This sentiment was echoed by Kelly, who lives with a degenerative eye disease and other health issues.

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

Kinsley noted in an interview that $2.4 million in insurance claims for dental services are already covered by the expansion. He said the move resulted in more than 150,000 prescriptions, most of which were given to people with asthma, epilepsy and blood disorders.

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

fight against prejudice

Not everyone is convinced of the merits of this measure.

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

“This is a big change for North Carolina, and there is still a lot of educating the public to do,” she said in a recent interview with NC Health News. “We want to fight the idea that Medicaid is not good health coverage or provides substandard health care.”

Some people worry that if they enroll in the program, their current health care provider will no longer see them or that they will be treated as a lower priority, Estes-Rogers said.

These concerns are “mostly unfounded,” she says.

“Most of our providers, especially in the metropolitan areas, accept Medicaid,” she said. “Generally speaking, not as many people are denied Medicaid as some people think. [presume] That's what they do. ”

DHHS is enlisting the help of faith leaders and civil society organizations to expand Medicaid coverage and spread the word about the many services. Kinsley said the department is also launching a public information campaign to “keep people coming forward and enrolling.”

“My biggest concern about acquisition, which is probably going to take the most time, is frankly the people who need it the most,” he said. “These are mothers and fathers with multiple jobs.” [whose] The schedule changes every other day. ”

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

“When we reach out to them through their church or other means and they finally have the moment to apply, we need to make it as easy as possible,” he said. .

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

In the months leading up to the expansion, health officials projected that 600,000 people would be added to the state's Medicaid rolls. Kinsley said the oft-touted number is an estimate of how many beneficiaries could get coverage over the next two years.

“We were unable to find any states that embarked on expansion and were able to exceed half of their projected goals by the first month, so we asked all the appropriate stakeholders,” he said.

Kinsley explained that many potentially eligible people were about to be removed from the rolls due to the “mitigation” that is occurring in response to the pandemic public health emergency. But state Medicaid programs were able to move hundreds of thousands of these people into family planning programs, keeping them eligible for meager benefits for the time being. Once the extension is deployed, it's now easy to upgrade to full coverage.

“We were able to move all these people very quickly because of the fact that we knew there were so many people as part of the public health emergency,” he said. .

NC Health News Editor Rose Hoban contributed reporting.