Jul 26, 2023 - News

NC begins preparations to launch Medicaid expansion Oct. 1

Illustration of a shadow about to sign off on the health symbol.

Illustration: Maura Losch/Axios

North Carolina health officials are moving ahead to implement Medicaid expansion in the state on Oct. 1, despite lingering uncertainty over whether the legislature will actually pass a budget that triggers implementation of the program.

Why it matters: The long-awaited, long-debated expansion would deliver full government health care coverage to about 500,000 of the state's poorest residents.

The intrigue: The N.C. Department of Health and Human Services' plans, announced Wednesday, indicate that the department is plowing ahead despite politics.

Between the lines: The legislature made Medicaid expansion law earlier this year, but it can't go into effect until they pass a budget.

  • It's unclear when that might happen.

What they're saying: "Moving forward now sets the department on a path to be able to get health care coverage to thousands of people as soon as possible," NCDHHS Secretary Kody Kinsley said in a release, first provided to Axios.

What's happening: To avoid any further delays in adding some of the state's poor to the Medicaid rolls, the federal government has agreed to allow state health officials to begin sending public notices to beneficiaries and making other preparations for expansion to begin.

  • So long as lawmakers usher a budget into law by Sept. 1, the state can begin expansion Oct. 1.
  • If that doesn't happen, the start date will be pushed back to December at the earliest, but could fall back into 2024, per the state health department.

Threat level: The announcement also comes as an estimated 9,000 North Carolinians have lost health care coverage in recent weeks.

  • Beginning in April, states across the country began reassessing Medicaid eligibility for residents who received coverage under its pandemic policy. North Carolina recipients who are no longer eligible began coming off the rolls this month.
  • Around 100,000 of those people statewide will once again be eligible when Medicaid expansion takes effect — but until that happens, many will be left in limbo.

"I'm going to get people on coverage as soon as possible," Kinsley told Axios in an interview Tuesday. "And I think it's incredibly even more real now that people have started to roll off with redetermination, at the rate of 9,000 people a month roughly, that are losing coverage for a number of reasons."


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