Medicaid expansion starts December 1, but what about those left behind?

On December 1, roughly 600,000 North Carolinians will become eligible for health care coverage, many for the very first time.

This new opportunity comes following years of advocacy work and the eventual passage of Medicaid expansion along with the state budget in September. But there are NC residents will remain ineligible for these benefits and other subsidies in the health insurance marketplace due to their immigration status.

Suzy Khachaturyan is a senior policy advocate for the North Carolina Budget & Tax Center. She spoke with WFDD’s David Ford about who’s in, who’s out, and the impacts on individuals and families.

Interview Highlights

On the many myths surrounding Medicaid expansion and immigration status:

"I think one of one of the most sort of pervasive, but also maybe more specific myths that I've heard, I think moreso from from immigrants is that U.S. citizenship is required for eligibility to receive Medicaid. And that is definitely not the case. While not all non-citizens are eligible on the basis of immigration status, it's also not true that you need to be a U.S. citizen. And then I think some of the other myths about, you know, public benefits more broadly, are concepts like the welfare queen, or things that, you know, [are]more pervasive, sort of like values, judgments that people placed on folks receiving public benefits when we know that they make a huge difference in people's lives. They help people meet their basic needs, meet the needs of their children, and so on.

"In the past five-plus years, information about what's what's technically called "public charge," or what is referred to as the "public charge rule," is something that that has gotten a lot of attention. And that has created a lot of confusion and misconception about who was eligible. And really, it comes down to fear that receiving public benefits will harm someone's ability or a family's ability to attain legal status in the future. And so you can see how that fear is pretty substantial, you know, it has has really serious ramifications."

On other obstacles to immigrant enrollment in Medicaid expansion: 

"Things like showing up at social services offices needing to frequently fill out new paperwork, sometimes very complex paperwork, that is difficult, even for myself as a native English speaker — someone with, you know, higher education under my belt — to understand. I think having that sort of expectation that folks jump through all of these hoops not just once, not just twice, but on a regular basis, just to be able to meet their basic needs, I think is a larger problem within the realm of how people have to access public benefits, even when they are eligible. And then I think, with respect to people who are not eligible, these are folks sort of in the margins of our communities. These are folks who are not just ineligible for the Medicaid benefits, they're very often ineligible for a whole slew of safety net programs that that would otherwise help them provide basic necessities for their family. We're talking food, we're talking shelter, access to health care, from addressing sickness to preventative care."

On reaching immigrant communities and providing Medicaid expansion information:

"That is a major challenge and a major opportunity. I think a lot of folks in these kinds of categories of immigrants, I think for lots of good reasons they've maybe, you know, written off these programs, and they just assumed that they're not eligible. I think they may be right. But I think there's value in just kind of reaching out to them, making sure they have the latest information and kind of understand their family's situation as in how these rules apply to their family. I think looking to a lot of grassroots organizations, community-based organizations with really deep ties to community groups that have a lot of trust built in these communities, often they're members of the community themselves. I think looking to them to try to do this, this deep engagement and community has always been important. And I think it's going to continue to be important as we move forward." 

Resources for Medicaid expansion requirements for immigrants in North Carolina:

North Carolina Justice Center

North Carolina Department of Health and Human Services

National Immigration Law Center

NC Navigator Consortium