300K in NC face removal from Medicaid End of pandemic-related Medicaid coverage could affect 300,000 in NC

Nearly 300,000 North Carolinians receiving COVID-19 pandemic-related Medicaid coverage could face being removed as a recipient as soon as July 1 and over the next 12 months.

However, the N.C. Department of Health and Human Services said it is working "to ensure people eligible for Medicaid do not lose coverage, and those no longer eligible are transitioned smoothly to affordable health plans or other health care options."

"Many of these beneficiaries will be eligible for health care coverage under Medicaid expansion, which the legislature recently passed, but cannot start until after CMS approves North Carolina's changes and a (state) budget is enacted."

NCDHHS said its goal during unwinding "is to ensure people who remain eligible for Medicaid continue to be covered and those who are no longer eligible know their potential options, such as buying coverage, often at a reduced cost, through the federal Health Insurance Marketplace."

On March 27, Gov. Roy Cooper signed the Medicaid expansion House Bill 76, surrounded by a bipartisan group of lawmakers, including Rep. Donny Lambeth, R-Forsyth, the sponsor of the bill.

The signing of the bill meant that between 450,000 and 650,000 North Carolinians are a step closer to having health coverage through Medicaid.

North Carolinians who would likely be eligible under an expanded program are those between the ages of 18 and 64 who earn too much to qualify for Medicaid coverage, but not enough to purchase coverage on the private insurance marketplace.

However, the state funding for expansion is contingent on Cooper signing the Republican-sponsored 2023-24 state budget, or allowing it to become law without his signature.

Without a signed state budget, the legislation in HB76 would expire on July 1, 2024, meaning North Carolina won't become the 40th expansion state.

With a signed budget, NCDHHS will submit a State Plan amendment to the federal Centers for Medicare and Medicaid Services.

"CMS has up to 90 days to review and approve the State Plan Amendment, or issue a Request for Additional Information that stops the 90-day clock," DHHS said.

"When N.C. Medicaid submits a response to the Request for Additional Information, the 90-day clock for review and approval restarts."

End of COVID-19 as health emergency sparks coverage changes

The May 11 ending of the national COVID-19 public-health emergency that began in mid-March 2020 is serving as the catalyst for several significant changes.

However, the U.S. Department of Health and Human Services has announced "new flexibilities" to help keep Americans covered as states resume Medicaid and Children's Health Insurance Program (CHIP) renewals.

The new flexibilities were sent to all 50 governors, urging them "to adopt all available flexibilities to minimize avoidable coverage losses among children and families."

"Nobody who is eligible for Medicaid or the Children's Health Insurance Program should lose coverage simply because they changed addresses, didn't receive a form, or didn't have enough information about the renewal process," U.S. Health Secretary Xavier Becerra said in a June 12 statement.

"We urge states to join us in partnering with local governments, community organizations and schools to reach people eligible for Medicaid and CHIP where they are."

Meanwhile, the CDC amended the conditions that states must meet to allow for a gradual removal of the temporary beneficiaries that could extend coverage through at least the end of the year.

NC DHHS strives 'to ensure people eligible for Medicaid do not lose coverage'

The N.C. Department of Health and Human Services has responded by saying "we recognize people will lose coverage in this process, but our goal is to ensure people eligible for Medicaid do not lose coverage, and those no longer eligible are transitioned smoothly to affordable health plans."

CMS amended the conditions that states must meet to allow for a gradual removal of the temporary beneficiaries that could extend coverage through at least the end of the year.

That includes determining if the temporary beneficiary now qualifies for permanent Medicaid coverage.

DHHS began the redetermination process April 1, with each renewal review taking up to 90 days.

"We expect to start the renewal process for the last group by March 31," DHHS said.

"We are currently reviewing the flexibilities recently proposed by the federal government and are eager to pursue additional flexibilities that best meet the needs of North Carolina."

State Medicaid officials have been working with county Departments of Social Services and other partners to reach as many beneficiaries as possible "to explain what they can expect and their potential options to obtain health coverage."

Beneficiaries have the right to appeal the decision by their local DSS, and information on this process is included in their notice of termination or reduced benefits.

"We expect to start the renewal process for the last group by March 31," NCDHHS said.

[email protected]@rcraverWSJ