How many North Carolinians could lose their health coverage?

North Carolina's legislators should act now

By: Kaylan Szafranski | August 2021

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As the pandemic set in, Congress acted quickly to ensure that Americans who enrolled in Medicaid due to job losses or other emergencies, couldn’t be kicked off the plan while the nation battled COVID-19. That was great news for thousands of North Carolinians who gained health coverage due to pandemic hardships. But that could change before long.

When the public health emergency period ends, which could come as soon as October of 2021, a harrowing process called Medicaid redetermination will begin. While it’s unclear how many people will remain eligible for Medicaid once the public health emergency ends, one thing is clear: Medicaid has been a lifeline for hundreds of thousands of North Carolinians during the pandemic. Unfortunately, tens or even hundreds of thousands of North Carolinians will lose their health insurance when the public health emergency ends, unless the NC General Assembly takes action to expand Medicaid to more low-income adults.

Take Action: Contact your NC legislators now and urge them to get Medicaid coverage to low-income North Carolinians.

Who is at risk of losing coverage?

C.R. is a new mother in Buncombe county, North Carolina. She and her husband are both independent contractors with highly variable incomes – and they took big hits during the pandemic. Thankfully C.R. was able to enroll in Medicaid, to cover the costs of prenatal care and childbirth for herself and her new baby. As it turns out, her baby was born prematurely and had to spend 5 weeks in the NICU, while C.R. recovered from an emergency caesarian.

“It is huge for our family that the medical costs were covered. If not for Medicaid, we would be bankrupt. We probably would not have a roof over our heads right now.” –C.R., Buncombe County NC

At 8 months old, C.R.’s new baby is thriving, and she is hoping to return to work. But she is one of the thousands of North Carolinians whose health coverage hangs in the balance. Without Medicaid coverage, the family will face the constant fear of medical bills they cannot afford.

The Kaiser Family Foundation estimates that during the height of the pandemic, more than 235,000 adults enrolled in Medicaid. Parents and pregnant women became eligible because they lost jobs, or had their hours cut, reducing incomes enough to make them eligible for the program. More children became eligible because of their parents’ income losses, as well.

What is the solution?

The federal government has offered North Carolina and 12 other states billions of dollars in incentives to expand our Medicaid program to cover low-income adults. North Carolina legislators can vote to expand NC Medicaid and accept those federal funds. Doing so would provide affordable, reliable health coverage to hundreds of thousands of low-income North Carolinians who currently have no other option. Parents like C.R. and her husband would gain the coverage they need to care for themselves, and their children. Coverage would continue even when the current public health emergency ends.

Who is covered by Medicaid now? And who is left out?

Currently NC Medicaid only covers low-income children and people with disabilities, and parents with incomes below 44% of the federal poverty line. In case you were wondering, 44% of the federal poverty line is $11,660 per year for a family of four, or $971 per month. Adults without children are not eligible at all.

The “coverage gap” leaves out low-income parents who earn above 44%, but less than 138% of the federal poverty line (about $3,000/month for a family of four). These parents can’t get any help with health insurance subsidies. Once their income reaches 138% of FPL, they qualify for a subsidized private plan in the Affordable Care Act marketplace.

The coverage gap leaves hundreds of thousands of low-income NC adults with no option at all for health coverage. About ¼ of them are parents with children at home.

How many people will lose health coverage when the public health emergency ends?

We don’t know for sure, since the majority of people enrolled will have to go through the redetermination process to find out whether they still qualify. Before the pandemic began, nearly 1.3 million adults in North Carolina had Medicaid coverage. According to research by the Kaiser Family Foundation, North Carolina experienced an enrollment increase of about 12.5% in 2020. That means more than 235,000 people enrolled in NC Medicaid during the height of the pandemic

What can families do?

If you or a family member are currently enrolled in Medicaid, you can check to see whether you will still be eligible for coverage once the public health emergency expires:

  • Review the Eligibility requirements to help you understand whether you may still be eligible for Medicaid coverage once the public health emergency ends.
  • Contact your local DSS office, or log in to your NCID account before September, to ensure that all the information they have on file for you is correct. Updating contact and income information can help you avoid any disruptions in coverage.

Medicaid has seen millions of North Carolinians safely through the COVID-19 pandemic. It is a comprehensive, proven health coverage program designed to help families and communities weather the storms in our lives. Thirty-eight other states have opted to maximize the value of Medicaid by expanding it to cover all low-income adults who were previously caught in the “coverage gap.” North Carolina should do the same. There’s no reason to cut off C.R.’s family, or anyone else, from this essential tool for public health and economic recovery.

Take Action: Contact your NC legislators now and urge them to get Medicaid coverage to low-income North Carolinians.