31,526 lost Medicaid coverage during August

An additional 31,526 North Carolinians lost their Medicaid coverage, at least temporarily, during August as part of the ending of the national COVID-19 public-health emergency in May.

On April 1, the state Medicaid program began a mandated recertification for an estimated 2.59 million Medicaid beneficiaries, or 23.9% of the state's 10.83 million residents. The process of Recertifications is scheduled to end March 31, 2024.

The federal Department of Health and Human Services had put those Recertifications put on hold for much of the pandemic.

The first five months of Recertifications covered 780,933 North Carolinians, of which 484,125 Recertifications had been completed by Aug. 31, according to the N.C. Department of Health and Human Services' website.

Of the 122,008 completed Recertifications during August, 74.2%, or 90,482 beneficiaries, were determined to be eligible.

About 22,548 individuals lost their benefits during August for procedural reasons, such as missing paperwork, incomplete documentation or could not be reached by a caseworker.

Another 3,982 North Carolinians were found to no longer meet eligibility requirements for any Medicaid program.

Altogether, 87,308 North Carolinians have lost their benefits for procedural reasons since June 30, while 12,617 were found to no longer meet eligibility requirements for any Medicaid program.

NCDHHS said it did not have a county breakdown of those affected.

NCDHHS said its goal "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."

The number of potential ineligible beneficiaries in N.C. and nationwide was reduced after the USDHHS approved "new flexibilities" to help keep Americans covered as states resume Medicaid and Children's Health Insurance Program (CHIP) renewals.

"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.

Medicaid expansion limbo

A Medicaid expansion expected to affect between 450,000 and 650,000 North Carolina again has been delayed — this time without a new projected start date — because state Republican legislative leaders have not agreed on a 202324 state budget.

Kody Kinsley, the state's health secretary, said on Aug. 28 that expansion would not start on Oct. 1.

Democratic Gov. Roy Cooper signed the bipartisan Medicaid expansion bill into law on March 27.

With a signed state budget, NCDHSS is authorized to submit a State Plan amendment to the Centers for Medicare and Medicaid Services.

However, without a signed state budget, House Bill 76 would expire on July 1, 2024, meaning North Carolina wouldn't become the 40th expansion state.

Cooper, Kinsley and other Democratic cabinet and legislative leaders had urged Republicans to reach a state budget compromise before Sept. 1 or remove Medicaid expansion funding from the budget.

House speaker Tim Moore, R-Cleveland, and Senate leader Phil Berger, R-Rockingham, have said they expect a budget compromise and final vote potentially by early next week.

Analysts say the refusal to separate Medicaid expansion funds represents leverage against a potential Cooper veto of the state budget bill.

Kinsley said delaying Medicaid expansion "tragically results in hundreds of thousands of people not being able to access care when they may need it most."

Kinsley expressed confidence that "nearly half of the people eligible for expansion (about 300,000) would be automatically enrolled in full coverage on Day One" despite current NCDHSS workforce shortfalls.

Some of those North Carolinians are included in the state's Family Benefits program that is a "light version" of what Medicaid expansion would provide, while others will be identified when they apply and determined to be ineligible for federal health insurance coverage.

"Each month of delay costs the state hundreds of millions of dollars flowing into communities across North Carolina to support care and treatment for people and help keep providers' doors open," Kinsley said.

Moving forward

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.

NCDHHS cited as examples that expansion would give health care coverage to single individuals making under about $20,000 a year. Likewise, a family of three earning under about $34,000 combined would be eligible.

Kinsley said DHHS continues to make progress on getting the "extensive policy and technical work" ready to go when funding is available.

NCDHHS said being able to take conditional enrollment steps will allow it to "reduce the original implementation period to as few as 30 days upon receiving legislative authority, from the initial projections of requiring between 90 and 120 days."

Kinsley said he is hopeful the House and Senate budget negotiations will yield healthcare benefits beyond Medicaid expansion, such as additional funding for behavioral and mental health services, and alleviate some of NCDHSS' workforce shortfall of up to 26% recently.