Another 33K in NC loses Medicaid during July Another 33,000 in NC lose Medicaid coverage during July

An additional 33,000 North Carolinians have lost their Medicaid coverage - at least temporarily - during July as part of the ending of the national COVID-19 public-health emergency in May.

That total is on top of 35,099 having their coverage ended during June, the first month where Medicaid beneficiaries were affected.

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 four months of recertifications covered 598,495 North Carolinians, of which 330,591 recertifications had been completed by July 31, according to the N.C. Department of Health and Human Services' website.

Of those completed recertifications during July, 74.5%, or 90,996 beneficiaries, were determined to be eligible.

About 89%, or 29,716 individuals, lost their benefits during July for procedural reasons, such as missing paperwork, incomplete documentation or could not be reached by a caseworker.

Another 3,584 North Carolinians were found to no longer meet eligibility requirements for any Medicaid program.

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

By comparison, during June about 85%, or 30,046 individuals, lost their benefits for procedural reasons, such as missing paperwork, incomplete documentation or could not be reached by a caseworker.

Another 5,053 North Carolinians were found to no longer meet eligibility requirements for any Medicaid program.

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

The conditional enrollment of between 450,000 and 650,000 North Carolinians into Medicaid expansion could start Oct. 1 as the result of a compromise reached between federal and state agencies.

However, NCDHHS cautioned July 26 that full enrollment remains dependent on funding allocated in the 2023-24 state budget legislation.

The compromise with the federal Centers for Medicare and Medicaid Services allows NCDHHS to proceed with required public notices for beneficiaries, counties and providers.

NCDHHS said being able to take the conditional enrollment step 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."

NCDHHS cautioned that if it does not gain legislative authority to move forward on Medicaid expansion by Sept. 1, the next potential start date would be Dec. 1.

Meanwhile, House speaker Tim Moore, R-Cleveland, has said the state budget bill will not be signed by Sept. 1.

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.

Stuck in neutral

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

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

With a signed budget, NCDHHS is authorized to submit a State Plan amendment to CMS.

Another part of the compromise with CMS allows NCDHHS to open the public comment period on the State Plan amendment. For more information on the public comment process, go to https://medicaid.ncdhhs.gov/medex-state-plan-amendment-new-medicaid-expansion-20230726/download?attachment.

Republican legislative leaders have not indicated a willingness to separate the Medicaid expansion funding because its inclusion represents leverage against a Cooper veto of the state budget.

Facing the reality of budget negotiations between House and Senate Republicans extending into at least August, NCDHHS said the compromise with CMS represents one strategy "to push forward preparations to maximize the benefit for North Carolina."

Potential aid

The Medicaid recertification initiative has prompted the 70 member clinics of the N.C. Association of Free and Charitable Clinics into ratcheting up its social media efforts to inform affected beneficiaries.

The association's clinics provide low-cost and no-cost health care to the uninsured. Combined, they serve more than 80,000 uninsured and underserved people in 87 counties.

Services include primary, specialty and dental care, behavioral health services, pharmacy, vision care, lab tests and hospital referrals.

The clinics said they are expecting an influx of new patients as North Carolinians learn of their ineligibility for Medicaid coverage.

"Our mission is that all North Carolinians have access to high-quality health care regardless of ability to pay," said April Cook, the association's chief executive.

Most clinics serve community residents who have no health insurance of any kind and household incomes at or below 250% of the federal poverty level.

"The vast majority of our clients work fulltime but are not offered health insurance through their employers and cannot qualify for Medicaid," Cook said.

"These are the frontline workers who provide essential services every day, and they deserve to be cared for, too."

For more information, go to www.ncafcc.org.

rcraver@wsjournal.com336-727-7376@rcraverWSJ