About 1,000 North Carolinians a day enroll in expanded Medicaid. Is that good?

Published February 8, 2024

By Lynn Bonner

About 1,000 people enroll each day in government health insurance under Medicaid expansion, state health officials told legislators Tuesday. 

Nearly 349,000 of the estimated 600,000 people who are eligible for health insurance under Medicaid expansion have come on since the Dec. 1 launch, the officials said. 

Sen. Ralph Hise, a Mitchell County Republican, asked why more of those eligible haven’t been enrolled. 

“How do we grow that?” Hise asked, noting that the new enrollment figures include people who gained insurance when they sought medical care at a hospital.

“The initial push doesn’t seem to be very significant,” Hise said. 

Kody Kinsley, secretary of the NC Department of Health and Human Services, told legislators that North Carolina is actually the envy of other states. 

Two legislative oversight committees, one on Health and Human Services and the other on Medicaid, met Tuesday. 

DHHS estimated it would take two years to enroll 600,000 people, Kinsley said. “About 1,000 a day is faster than we expected over a two-year time window.”

Jay Ludlam, deputy secretary for Medicaid at DHHS said later that the 1,000-a-day pace will not remain consistent. 

Last year, North Carolina became the 41st state, including Washington DC, to adopt Medicaid expansion.

Though a handful House Republicans backed expansion for years, most Republican legislators were opposed. Republicans repeatedly blocked Democratic legislators’ efforts to debate expansion. The tide began to turn in 2022 when Senate leader Phil Berger changed course and announced his support for expansion. Berger had been one of idea’s staunchest opponents.

The day expanded Medicaid launched, nearly 273,000 people were automatically enrolled. These were beneficiaries of family planning Medicaid that the state Department of Health and Human Services knew qualified for full benefits. 

In the last few months, community groups, the NC Navigator Consortium, and DHHS have conducted community meetings, hit the airwaves, and answered questions on Facebook to spread the word about expanded Medicaid and how people can enroll.

The federal government pays 90% of the cost of the people enrolled in expanded Medicaid. Hospitals and other entities pay the rest. None of the money for it comes out of the state budget. 

Notably, while the state is spreading information about Medicaid expansion, it is also cutting thousands of people off regular Medicaid each month

During the COVID-19 pandemic, the federal government told states not to cut off people’s Medicaid coverage. In exchange, states received more money to help pay for the insurance coverage. That ended last year, and all states have since returned to conducting annual checks of enrollees’ eligibility.

Some people who qualify for expanded Medicaid were able to gain insurance through the eligibility checks.

Medicaid enrollment swelled during the pandemic, making for extra work for county social services workers who check beneficiaries’ eligibility. 

Most people have their Medicaid insurance renewed without having to connect with a county worker, Kinsley said. Renewals are based on information the state already has — income and household information that recipients of food assistance submitted, for example. The state also received permission to pause checking children’s Medicaid eligibility for a year, easing the counties’ workload. 

Covering children doesn’t cost very much, and most of the children counties checked were still eligible, Ludlam said. About 25% of the children who lost their Medicaid regained the insurance within three months, he said. 

Checking children’s eligibility “didn’t seem like the best use of county worker time,” Ludlam said. “We want them to focus on the adults that are the cost drivers of the program.”