N.C. Medicaid Expansion program exceeds initially anticipated enrollment rates

In December 2024, Gov.Roy Cooper and the North Carolina Department of Health and Human Services announced over 600,000 people enrolled in Medicaid Expansion in the first year of implementation in half the time that was initially projected. 

The Medicaid Expansion program, launched on Dec. 1, 2023, provides health coverage to residents aged 19 through 64 with incomes up to 138 percent of the federal poverty line. 

Josh Dobson, president and CEO of the North Carolina Health Association, said when the Affordable Care Act passed in 2010, Medicaid was supposed to expand coverage to individuals earning up to 138 percent of the federal poverty level. However, North Carolina chose not to implement the expansion until December 2023, leaving a gap where individuals earned too much to qualify for traditional Medicaid but not enough to access the ACA exchange.

“Medicaid Expansion in North Carolina has allowed hard working North Carolinians to gain access to health care that otherwise would not have that health care,” Dobson said. 

Jay Ludlam, deputy secretary for N.C. Medicaid, said lessons learned from other states, extensive data use and streamlined eligibility systems contributed to the enrollment success. He said they used data gathered during COVID-19 to help identify eligible individuals, enrolling 268,000 people based on existing information in one day. 

Ludlam said advocacy groups, community organizations and faith-based groups also played critical roles in the success of Medicaid Expansion by hosting events and attending community fairs. He said the N.C. Medicaid Ambassador Initiative empowered individuals to help spread the message and assist with enrollment. 

“We had a number of librarians across North Carolina who were really interested in helping people who came to their local library get enrolled,” he said. 

According to the NCDHHS press release, North Carolina enrolled nearly 300,000 people receiving Medicaid Family Planning benefits -– which provide contraceptive services to people who are not fully enrolled in Medicaid — into full Medicaid coverage. Additionally, more than 217,183 members of rural communities gained access to Medicaid coverage through the expansion. 

Ludlam said the expansion creates a greater sense of certainty for both individuals seeking care as well as providers. Before the expansion, he said many people chose to not pursue critical medication or care because they did not have coverage. Many health providers were not reimbursed for their services or had to go through the process of filing paperwork to attempt to have the federal government pay, Ludlam said.

Jonathan Oberlander, professor of health policy, social medicine and political science at UNC, said Medicaid Expansion is one of the most important achievements North Carolina could have accomplished to improve population health. He also said gaining Medicaid coverage not only ensures access to medical care but also offers critical financial protection, which is important. 

“There is accumulating evidence that Medicaid saves lives, that when states expand Medicaid and more low-income persons gain access to health care coverage and to medical care, mortality falls in the states,” he said. 

Oberlander also said the expansion was a priority for Cooper from the beginning. He said it was held up for over a decade due to partisan conflicts, so the implementation is remarkably important and will continue as a part of his legacy. 

He also said when Medicaid Expansion finally passed in North Carolina, it was approved through a bipartisan vote, with support not only from Cooper but also from Republican leadership in the legislature. 

With the expansion, Ludlam said the state now has the people and the access that is needed to make all of the pieces start to work together that will cause health improvements across North Carolina.

“The fact that we've exceeded those initial enrollment projections, underscores just the intensity of the need in the state for health insurance,” Oberlander said. 

@DTHCityState | city@dailytarheel.com