No Medicaid Expansion in NC Means Limited Options For Some Residents

Health officials say thousands of people in North Carolina still won’t have health insurance this year, despite implementation of the Affordable Care Act.  

North Carolina is one 26 states where lawmakers rejected Medicaid expansion, which is something that the U.S. Supreme Court gave them permission to do. According to the North Carolina Institute of Medicine, the move would have would have covered an additional 500,000 residents.

“Based on numbers provided to us we think approximately 11,105 residents will still be uninsured in Davidson County, even with the Affordable Care Act,” says  Jen Hames, Health Education Supervisor at the Davidson County Health Department.

Hames says there are a lot of concerns about those who fall in the Medicaid coverage gap in North Carolina. For example, if you are a single adult with no dependents, that’s where Medicaid expansion is having the biggest impact.

“If they go in and enroll based on their income they are going to qualify for Medicaid, but they are not going to be covered in N.C. If they went and purchased a plan, they are going to end up spending more than 9.5 percent on that plan, which puts them over the allowable amount that they should be paying out of pocket for a plan, so they still aren’t going to be insured because they won’t be able to afford it,” says Hames

N.C. lawmakers also opted not to create a state-run health exchange, citing cost and other factors. Because of that decision, NC also lost out on millions of dollars in outreach funds for more enrollment support.

Scott Edmonds is with MDC, a non-profit organization based in Durham.  MDC is among several non-profits throughout N.C. that received funding from the federal government to pay for healthcare navigator positions, which provide one-on-one assistance. He says thousands of North Carolinians are expected to fall within the health insurance gap.

“You end up being too poor for Medicaid, which is really an unfortunate situation because you have to have a certain amount of earned income, I think around $15,000 for an individual, just to get to the point where you can be  eligible for  subsidized insurance,” says Edmonds.

Under the Affordable Care Act, those who do not have health insurance will face a tax penalty. The penalty is $95 per adult and $47.50 per child or 1% of your taxable income.

Jennifer Simmons is the navigator project director with Legal Aid of North Carolina. The agency is also one of the official healthcare navigators in state to help residents enroll in the new health insurance marketplace.

“The general rule is that everyone is required to have health insurance effective January 1, 2014. People have until March 31, 2014 to get that into that in place. However, the government has set up exemptions for that penalty. One of those exemptions is for people who are either under 100 percent the federal poverty level or would have qualified for Medicaid if North Carolina had chosen to expand, so those people are certainly welcome to shop and to see if they can afford to buy it but if they can’t afford to buy it, they will not be penalized for failing to do so,” says Simmons.

In North Carolina, Medicaid provides health coverage to 1.5 million low income children, families, pregnant women, the elderly, and people with disabilities. The program is one of the state’s biggest expenditures, using more than $13 billion a year in federal and state money to treat residents.

Edmonds says despite the state’s decision not to expand the program, a small percentage of people will now qualify for Medicaid who didn't before.

“Even though Medicaid wasn’t expanded by law in North Carolina, there are some eligibility changes that will in fact expand the pool of people, even though it doesn’t go up all the way to the 133 percent of the federal poverty level, so there are some changes that will make more people eligible starting January 1, just because of the way they have redesigned the eligibility criteria,” says Edmonds.

But expanding healthcare coverage to more residents in the state couldn't come any faster in Forsyth County.

Joe Raymond is Director of Forsyth County Department of Social Services.  He estimates 20,000 to 25,000 people would have been eligible for health insurance in the county, if Medicaid had been expanded in North Carolina.

“We watch families with few means routinely struggle with the trade-off  between working and making a little bit more money and then not being eligible for public benefits or Medicaid, and so healthcare in many ways is the lynch pin issue for families in this country and I think this story is only beginning on how it will play out nationally and in NC,” says Raymond.

Meanwhile, a new state hotline has been set up to help N.C. residents enroll in the new health insurance marketplace. Residents can call 1-855-733-3711 to arrange an in person appointment with a health insurance navigator.