Expanded Medicaid is finally here for 3,000 uninsured in Haywood [The Mountaineer, Waynesville, N.C.]

Nov. 28—The year 2024 could become a life-changing one for about half a million people in North Carolina — 3,000 people in Haywood — who lack access to affordable health care.

Medicaid will finally be expanded in North Carolina for 2024 after years of partisan, political infighting over the issue. Failing to expand Medicaid trapped thousands of low-income people in a coverage gap — making too much to qualify for Medicaid but not enough to qualify for subsidies through the federal insurance marketplace. Most went without health insurance, unable to afford out-of-pocket rates.

That gap will be bridged now that the N.C. General Assembly approved legislation Medicaid expansion. North Carolina was one of the last states to do so, with only nine other holdouts remaining.

The good news for the state budget is that legislators negotiated a deal with hospitals to cover the state's 10% cost share to expand the program. The rest of the tab is picked up by the federal government, but the state 10% share had been the sticking point for the Republican-controlled General Assembly.

N.C. Sen. Kevin Corbin, who represents the far western counties of the state, including Haywood, was a key player in bringing the expansion about. As chairman of the Senate Appropriations Committee on Health and Human Services, Corbin was integrally involved in all aspects of the process.

"The big picture is this will help everybody," Corbin explained. "The state will be getting federal dollars we previously were not receiving, hospitals will be getting paid for services they are already providing, and many of those uninsured will be getting the health care they need. It's a win all around."

Corbin estimated the smaller hospitals in his district would receive an additional $1 million to $2 million each year in Medicaid payments, a big plus considering the hospitals were providing the care in most cases anyway and having to write off the bills for that care. Even with ponying up the state's match, hospitals will come out far ahead, he said.

Corbin wasn't sure how other states came up with the 10% match but believed North Carolina was unique in this approach.

The fourth part of the "win" will be for all residents in the state when the cost of health insurance goes down.

"We've looked at other states and have seen health insurance rates go down," Corbin said in reference to expanding Medicaid within a state. "You are insuring previously uninsured people, but there is no free lunch. Somebody is paying for it, and that's because people with insurance are paying more."

The other good news accompanying the expansion decision is something of a "bonus" which will provide the state $1.5 billion to use toward other healthcare projects, Corbin said. While the specifics on how the funds are to be used are not yet finalized, there's a pledge to use at least $500 million toward addressing the shortage of mental health facilities in the state, he added.

A bit of history

For years, North Carolina resisted the incentives offered under the Affordable Care Act passed in 2003 to expand Medicaid so a broader range of low-income individuals would qualify.

Medicaid is the federal insurance program for those with incomes at or below the national poverty level. Medicare, on the other hand, is the federal insurance program for those 65 and older, regardless of income level.

The expanded Medicaid guidelines in North Carolina widen the income levels regarding eligibility.

When the legislation was finally passed this spring, North Carolina became the 40th state in the union to offer the expanded Medicaid program.

Republicans in control of the N.C. General Assembly over the past two decades were generally opposed to expanding Medicaid because they feared the federal government would renege on the promised 90% match, were concerned that the cost of Medicaid would spiral out of control and feared the new entitlement would create a disincentive to work.

Corbin said the tide turned after legislators saw that the Medicaid transformation program the state implemented in 2021 was indeed controlling the Medicaid costs in the state by switching to a managed care system.

This switch divvied up the state's population between six managed care companies, four of which operate in Haywood, and the organizations are required to cover healthcare costs for the thousands of patients on their rolls. This provides a more stable cost when it comes to budgeting as opposed to the traditional fee-for-service payments under the old system, Corbin said.

"We made the system more efficient," he said. "We didn't want to add more people to an inefficient system."

Secondly, since the expanded Medicaid program is for those between the ages of 19 and 64, most in that group are already working, and it is unlikely they would quit a job to become eligible.

Last but not least, Corbin said study after study has found providing preventive, routine health care is by far the best way to control healthcare costs.

"Every healthcare provider will tell you you are infinitely better off, and it's less expensive when you emphasize preventive care," Corbin said. "It's been proven that if people have no insurance, they typically don't get regular care and end up waiting until a crisis to seek help. This is the most expensive type of care out there."

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