CMS agrees to allow conditional enrollment toward NC Medicaid expansion

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

However, the N.C. Department of Health and Human Services cautioned Wednesday 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.

"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," state Health Secretary Kody Kinsley said in a statement.

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.

Cooper and other Democratic cabinet and legislative leaders have urged Republican legislative leadership to either reach a state budget compromise before Sept. 1, or removing Medicaid expansion funding from the budget.

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."

"Medicaid expansion will be transformative for access to health care in rural areas, for better mental health and for veterans, working adults and their families while bringing billions in federal dollars to the state," NCDHHS said.

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