North Carolina received a crucial green light from the federal government to expand its Medicaid program, keeping the state on track to provide publicly funded health insurance to hundreds of thousands of residents on December 1.
The North Carolina Department of Health and Human Services announced Friday that the state received final federal approval from the Centers for Medicare & Medicaid Services, a required step in finalizing the December launch. Medicaid expansion broadens available health coverage for people ages 19 through 64 years, closing the gap between those who earn too much for traditional Medicaid but too little for subsidized private insurance.
North Carolina was one of only a handful of states to decline Medicaid expansion since the federal government offered the coverage as part of the Affordable Care Act in 2012.
The program pays for doctor visits, yearly check-ups, emergency care, mental health and more — at little or no cost to participants.
Although the expansion was passed by the state legislature and signed into law by Gov. Roy Cooper in late September, the October 1st start date, delays by the legislature in passing a budget pushed the start to December. The hold-up gave counties more time to prepare but continued to deny coverage to the an estimated 600,000 residentswho will become eligible under the expanded plan.
Extra time for Medicaid rollout is a double-edged sword
“While a delay will provide us more time to fill the expansion positions allocated, it is unfortunate that it means that eligible Macon County adults and families will continue to wait to be able to meet their health care needs,” Macon County’s director of Social Services Patrick Betancourt told BPR in September when the expansion delay was announced.
At the time, the county was trying to fill three new positions to take on the additional Medicaid patients. That delay came with a cost for local families, Betancourt explained.
“Regrettably, this delay means that working adults and their families eligible for expansion will continue to miss the security that access to health care brings,” he said.
The county filled the three positions in the last few weeks. Along with ongoing training, the department used the extra time to review policies and procedures.
According to the latest data from the state, an additional 3,200 people in Macon County will be eligible for Medicaid in December, but Betancourt was quick to point out that those numbers were more than a year old and Macon County has experienced a nearly three percent population increase over the past two years.
While the additional cases will be a challenge for the department, Betancourt said he hears stories everyday from families in need of care. Right now, many of those families don’t qualify for Medicaid but will on December 1.
“Countless times, we hear stories similar to one I heard this morning: a 10-year-old girl whose mother died from an overdose several years ago has significant counselling needs arising from the trauma and loss of her mother’s passing. The grandparents raising this child are on a fixed income but make just over the income limits for Medicaid,” he told BPR this week. “Expansion will make a real difference to this family while at the same time bringing millions of federal dollars back into North Carolina. “
Bringing on new staff requires more than hiring. The training period to become a Medicaid caseworker can take as long as a year, according to Jerrie McFalls, Henderson County Department of Social Services Director.
More Medicaid eligibility could impact access to care
Jackson County Department of Social Services Director Cris Weatherford said the department is working to fill four new positions to deal with about 4,000 new Medicaid cases.
“It's going to really help out folks that are that have been in that gap, and people that really do need some assistance now that other prices have really gone up with gas and food and rent,” Weatherford told BPR in September.
In August, Weatherford appealed to the Jackson County Commissioners to allow the department to post the jobs and start the hiring process even though the budget wasn’t passed. Ideally, the jobs would have been posted earlier but Weatherford explained that without the final state budget in place there was reluctance to commit to the new positions.
“If I had staff in the building today that wouldn’t be enough time to get four folks trained and up and ready to roll with this so we are all kind of in this really weird spot with trying to figure out how the cart and the horse are going to work together in this situation,” Weatherford told commissioners at the meeting where the posting was unanimously approved.
“I think a lot of counties and county managers and county finance folks were real reluctant to kind of trust that [October 1] date and not knowing when it was actually going to occur because we could go ahead and spend that money and create these positions. If we don't have the funding on the backend coming in to continue those, then the county could have been on the hook for the funding for that until the budget passed,” Weatherford said.
As he works to fill new positions, Weatherford said he felt the same tension as his colleagues across the region between the additional time that the new December 1 roll out date provides and the needs for care.
The region is already strapped for mental health and medical care, he said.
“I'm excited that it's going to bring the option for folks to have this coverage and be able to go to the doctor and you know, time will tell, and the medical community will have to figure out how to meet that need,” Weatherford said.
All hands on deck in Buncombe County
Buncombe County hired 15 new case management staff to handle the estimated 15,000 new Medicaid applications that will start coming in December. Economic Services Program Administrator Phillip Hardin said a handful are still being trained. He said it has been “all hands on deck” to prepare for the rollout.
“We are using state resources and our local networks to develop an outreach and communications plan tailored to our community,” Hardin said, adding that the department’s progress is “tracking along nicely.”
The state allocation is not enough for the county to fully staff the projected new cases, he said and the department will assess caseload growth as applications are received.
Counties across the state will find out exactly what the new needs will be on December 1, when the application period for those who now are eligible for Medicaid Expansion begins. Here’s more information about how to apply for Medicaid.
