North Carolina Medicaid expansion set to launch Dec. 1

Medicaid expansion will launch in North Carolina on Dec. 1, Gov. Roy Cooper (D) announced Monday, marking the culmination of a long-fought campaign from Cooper and health groups.

North Carolina Republicans refused for more than 10 years to accept federal funding to help expand coverage to low-income people. There are now only 10 holdout states remaining.

According to the state Department of Health and Human Services, the expansion will allow about 600,000 North Carolinians to qualify for coverage. The department anticipates about 300,000 eligible people will automatically be enrolled starting Dec. 1.

All adults ages 19-64 who earn up to 138 percent of the federal poverty level — about $20,000 for an individual and less than $34,000 combined for a family of three — will be eligible.

Previously, Medicaid covered parents earning up to only 41 percent of the poverty level — about $8,000 combined for a family of three. Childless adults had no coverage. 

“Finally expanding Medicaid in North Carolina is a monumental achievement that will extend health insurance to people who need it,” Cooper said in a statement. “This means better health care, including those with mental health and substance abuse disorders, hope for rural hospitals struggling to stay open and billions of dollars for our economy. This action is long overdue, and we aren’t wasting a moment in beginning enrollment in North Carolina.”

As part of a deal with the veto-proof GOP majority in the General Assembly, Medicaid expansion could only be implemented as part of a state budget, rather than as a stand-alone bill. The budget was delayed, and Republicans eventually included numerous policies Cooper said he opposed. 

But instead of a veto, Cooper allowed it to become law without his signature to start implementing the expansion.

“I will not allow people who are crying for help to wait any longer,” Cooper said Friday. 

But, he added, “overall this is a bad budget that seriously shortchanges our schools, prioritizes power grabs, keeps shady backroom deals secret and blatantly violates the constitution, and many of its provisions will face legal action.”

According to health policy research group KFF, Texas and Florida now represent more than half the people in the “coverage gap,” where poor residents make too much to be eligible for strict state Medicaid limits, but below the federal poverty level, making them ineligible for ObamaCare subsidies.

The Affordable Care Act made it mandatory for states to expand Medicaid for everyone earning up to 138 percent of the poverty level. Because the law did not envision it becoming optional, there is no mechanism to make subsidies available for people earning below the poverty level in states that refuse expansion funds.