NC Medicaid expansion takes effect. How to check eligibility and get health care coverage
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North Carolina’s expanded Medicaid program officially launched Friday, opening the door for hundreds of thousands of people across the state to access health insurance.
Under the expansion, which was signed into law in March, an additional 600,000 North Carolinians are eligible for Medicaid, including 300,000 who will be automatically enrolled. North Carolina is the 40th state to expand Medicaid under the Affordable Care Act.
Gov. Roy Cooper, who visited Charlotte Friday with other state and local officials, told the crowd gathered at the Goodwill Opportunity Campus that the occasion marked the end of “a long and winding road.”
“A dream a decade in the making finally becomes a reality,” he said.
Under the expansion, adults who make below 138% of the federal poverty level are eligible for Medicaid. That includes an estimated 600,000 North Carolinians, the state’s Department of Health and Human Services said previously. Many of them previously earned too much to qualify for Medicaid but not enough to receive subsidies to buy other insurance — falling into a coverage gap.
Those currently receiving family planning benefits who qualify for full Medicaid coverage under the expansion, about 300,000 people, will be automatically enrolled, NCDHHS said previously.
One of the 300,000, Penelope Wingard, received her Medicaid card from Cooper at Friday’s event. An emotional Wingard told the crowd about her experience struggling to find care and racking up thousands in medical debt when she lost her health insurance while undergoing treatment for breast cancer.
“It’s like I got sick and I got punished for it,” she said, adding that her tears Friday were “tears of joy.”
Carolyn Allison, CEO of the Charlotte Community Health Clinic, said Medicaid expansion will be a game-changer for patients like Wingard and the 70% of patients who visit the clinic and are uninsured. She estimated about half of those uninsured folks will now be eligible for Medicaid.
The expansion also drew praise on a national level, including from President Joe Biden.
“Every American deserves high-quality affordable health care. Today, we are one step closer towards meeting that promise,” Biden said in a statement.
Enrollment work begins
While Charlotte hosted the kick-off, nonprofits and organizations had enrollment events across the state to help people newly eligible learn about expansion and apply.
One was at Martin Street Baptist Church in southeastern Raleigh. It was hosted by the NC Navigator Consortium, the state’s only federally funded navigator entity that offers free consultation and support to insurance seekers, including via Medicaid and the federal marketplace.
While Medicaid expansion in North Carolina is historic, the church was fairly quiet on Wednesday, with only a slow stream of people milling in and out throughout the day. For Sammy Leach, communications director for the consortium, this was not surprising.
Enrollment efforts will be a years-long project. In particular, work will need to be focused on the state’s rural areas, he said. To help with accessibility, “we try to make sure we put them in public locations that are easy access to get to… libraries, government buildings, local hospitals, local clinics, access to public transportation,” he said.
Yanic Kasongo, a 34-year-old from Raleigh, got help Friday from navigators to enroll under the expanded parameters. Previously, Kasongo had Family Planning Medicaid, which covers limited services, he said. His mother, who had insurance through the federal marketplace, pushed him to meet with a navigator and get help.
He originally hoped to enroll in a federally subsidized health plan, but the marketplace’s system flagged him as eligible under the expanded Medicaid program, said Juanita Thomas, the navigator who helped.
Kasongo said his current insurance “never covered anything,” and “then after that I received bills, but I never knew why,” he said. With better insurance, he hopes to be able to get care without fear of hefty bills, he said.
Medicaid expansion in NC was bipartisan
Republican legislative leaders have long been wary of expansion, the News & Observer reported previously. But they began to warm to the idea in 2022 when the federal government offered a $1.8 billion bonus over two years if North Carolina signed on.
Cooper said Friday the expansion deal was “bipartisan” and that he thinks North Carolina’s plan can serve as a blueprint for other states who haven’t yet expanded Medicaid. The compromise bill passed both chambers of the state legislature in March, with funding tied to the state budget.
“This is what happens when we work together for good,” he said.
Cooper said it’s possible Republicans could follow through on their oft-repeated promise to repeal the Affordable Care Act, the federal law that opened the door for expansion, if they take control of Congress and the White House. But he believes the bill and Medicaid expansion are popular with voters across the political spectrum.
“It’s still in peril … The next elections will be very telling on whether we can maintain what we have,” he said.
Here’s what to know about getting coverage under North Carolina’s expanded Medicaid program:
Who is eligible for NC Medicaid under expansion?
Under Medicaid expansion, most people are eligible for coverage if they are:
A U.S. citizen living in North Carolina
Between the ages of 19 and 64 years old
And have an income of $1,676 per month or less for a single adult, $2,267 per month or less for a family of two, $2,859 per month or less for a family of three or $3,450 per month or less for a family of four.
The income threshold rises by $591 per month for each additional family member after four.
To check eligibility, visit medicaid.ncdhhs.gov/eligibility. People can also call the NC Medicaid Contact Center at 1-888-245-0179, or reach the NC Navigator Consortium by calling 1-855-733-3711 or visiting ncnavigator.net.
Some non-U.S. citizens may also be eligible, and people who are pregnant “may be eligible for other Medicaid programs to get full health benefits,” the state adds. Certain lawfully present immigrants and green card holders can also purchase coverage from the marketplace, if they do not qualify for Medicaid.
That was the case for Shelagh Boughton, who was at Martin Street Baptist Church in Raleigh to enroll with her husband, Sammy Surface. Boughton, who is 74, moved to the United States after getting married. While here waiting for her permanent resident card for over two years, she’s been without insurance.
During that time she faced a medical emergency that led to a bill of more than $1,000. And while she learned Friday she was not eligible for Medicaid, Boughton was eligible for a subsidized federal plan. She felt “a big relief,” knowing she’d soon have coverage.
Nicholas Riggs, director of the NC Navigators Consortium, told The N&O, “this is a day that we’ve been looking forward to for 10 years in North Carolina.”
“So very exciting times, very much looking forward to assisting North Carolinians both with Medicaid coverage, marketplace coverage, and I think that for us, whether folks are eligible for Medicaid or marketplace, we’re able to assist with both.”
How to sign up for NC Medicaid
There are multiple options for signing up for North Carolina’s expanded Medicaid program.
To apply online, visit epass.nc.gov. People can also apply by phone by calling the NC Medicaid Contact Center at 1-888-245-0179 or calling your county’s Department of Social Services office.
Those looking to apply by mail, fax or email should download an application from medicaid.ncdhhs.gov and send it to their county’s social services office.
To apply in person, visit your county’s social services office. Walk-ins are welcome, but the state recommends making an appointment ahead of time by calling the office or the NC Medicaid Contact Center.
Applicants need to provide their full legal name, date of birth, mailing address and signature to apply.
Applicants may also be asked to provide documentation including:
Proof of identity, such as a driver’s license or school ID
Proof of North Carolina residency, such as a photo ID with your address, a utility bill, a lease or documentation of employment
Your Social Security Number
Employer and income information for you and others in your household, such as pay stubs, W-2 forms, tax returns or business records
Award letters from other sources of income, such as Social Security, retirement benefits, pensions, veterans benefits or child support
Copies of all medical or life insurance policies
Recent bank statements
Lists of all real property you own and all cars, trucks, motorcycles or boats you or others in your household own
“You can apply with an application that is missing information and add it later. However, giving as much information as possible may help you get a decision faster,” the state says on its Medicaid website.
It can take up to 45 days for social services to make a decision on applications, or up to 90 days for disability applications. Social services may contact applicants for more information.
Other health insurance options
People who still don’t qualify for Medicaid but need health insurance have other options.
For those 65 or older, open enrollment for Medicare runs through Dec. 7.
People also can search for health insurance plans through the federal marketplace and see if they qualify for a health care subsidy through Dec. 15 at healthcare.gov.
North Carolinians can reach the NC Navigator Consortium by calling 1-855-733-3711 or visiting ncnavigator.net to get additional assistance finding an affordable plan and signing up for insurance.
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