Friday is a day thousands of people have been waiting for: after years of legislative wrangling, advocacy and political back-and-forth, Medicaid expansion takes effect in North Carolina.
We’re the 40th state to expand access to Medicaid. Deputy Secretary of North Carolina Medicaid Jay Ludlam joined WFAE's Nick de la Canal to discuss the rollout and how the expansion could affect healthcare for hundreds of thousands of people.
Nick de la Canal: So Medicaid of course is a government-funded health insurance program. Can you refresh us and give us a sense of who it's for and what it covers?
Jay Ludlam: Absolutely. So Medicaid is a program that typically covers children, pregnant women, individuals with developmental disabilities, traumatic brain injury, substance use disorders. For most North Carolinians, this is a program that their neighbors and other community members likely are participants in.
De la Canal: And before today, to qualify for Medicaid in North Carolina as an adult, you had to be both poor and you had to be disabled, pregnant or over the age of 65 — or have kids and an extremely low income, like a couple hundred dollars a month. So how is that changing?
Ludlam: Now adults ages 19 to 64 who earn up to 138% of the federal poverty line may be eligible. And so what that means is that for single individuals earning about $20,000 a year, or families of three earning about $34,000 a year, they'll now have access to full Medicaid coverage under the Medicaid expansion program.
De la Canal: Yeah, and I think $20,000 a year translates roughly to like a full-time job paying about $9.60 an hour — just to give people an idea — and the state estimates there are 600,000 people in this newly eligible group. How are these people currently getting health insurance?
Ludlam: Many of them aren't. We do have approximately 270,000 to 280,000 individuals who we will be moving into Medicaid expansion on Dec. 1 who are currently in our limited benefit family planning program. What that means is they have only a small amount of services that are specialized or focused on, for example contraception or to address sexually transmitted diseases. So that is a limited benefit.
But now with Medicaid expansion, those 270,000 individuals will have access to pharmacies, physicians, primary care docs. They will have access to mental health and behavioral health resources, as well as access to those services that are needed to support addressing substance use disorder or other issues.
De la Canal: And that state has said that this expansion would be transformative for rural areas. Why rural areas?
Ludlam: North Carolina has one of the largest rural populations in the country. I believe that we are number two in terms of rural populations, and access to healthcare in these communities is sometimes challenging, in part because of the rural nature, the distances that must be traveled, as well as the opportunity to bring in skilled physicians and other professionals who can serve those communities.
With Medicaid expansion and the ability to guarantee that a large portion of those individuals in rural communities now can afford and have access to healthcare, that brings with it money, and that money will be money that can be used within those communities to pay for and to attract other physicians and specialists to come into those communities across rural North Carolina.
De la Canal: So you also mentioned that roughly half of these 600,000 newly eligible people are automatically enrolled on Friday, day one. Is the state and are county offices prepared to handle that enormous number of sign ups on day one, and potentially thousands of more applications in the coming months?
Ludlam: That's a great question. We do expect that county offices will have long lines, that there will be a lot of interest from North Carolinians in whether or not they are eligible, and we are seeing already some high call volumes on our call centers. We are hearing about strong foot traffic into our local DSS offices, but we do believe that with careful preparation, we will be able to manage this wave of individuals coming in, and then continue to support the counties as more and more people hear about the program and get excited over the coming months.
De la Canal: Well again, this has been a long time coming. Even after expansion was approved, the rollout was delayed by several months as the General Assembly worked on a state budget. Are you happy this day is finally here?
Ludlam: That is a great question. We are so happy. I have staff members who have worked on this initiative for ten years. This really is one of the best days for the program.
