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Medicaid Expansion Now Offered in North Carolina; Projected to Be Especially Beneficial to Many High Country Residents

By Tim Gardner

More than an estimated half-million North Carolinians stand to gain free or extremely low-cost health coverage now and in the coming months, according to the North Carolina Department of Health and Human Services (NCDHHS).

Medicaid expansion began on December 1 and as a result, more North Carolinians are eligible than ever before to receive health care coverage through the program, including many who did not previously qualify. 

Medicaid expansion has made low-income adults ages 19 to 64 who have incomes up to 133 percent of the Federal Poverty Level eligible to enroll in it. That is approximately $20,000.00 for a single person, $27,000.00 for a family of two, $34,000.00 for a family of three, or $41,000.00 for a family of four. 

Medicaid applications are open year-round to United States citizens.  The health care program is available in all states, but North Carolina offers more services in its expanded Medicaid program than many states.

Those eligible for Medicaid through its expansion do not have to be disabled or have a child or children under the age of 18 in their home. A person can have Medicaid if he or she also has Medicare, but not under the Medicaid expansion program.  The only other restriction is that a child or children under the age of 18 are required to have other full insurance coverage before his, her, or their parent or parents can qualify for Medicaid coverage.

North Carolina Medicaid is free to most consumers and provides comprehensive coverage to all beneficiaries, meeting some of their needs that other insurances do not cover.  Those Medicaid covers include primary care visits, dental care, vision needs like exams and eyeglasses, hearing needs such as exams and hearing aids, hospital stays, and maternity care.

Medicaid also pays for doctor visits, yearly check-ups, emergency care, mental health needs, and more, again with no or little cost to the patient.

Many people have $0.00 or no co-pays when they visit a doctor, dentist, audiologist (hearing doctor), and/or optometrist (eye doctor). And those who do not have $0 or zero co-pays have very low co-pays such as $3.00, $4.00, $5.00, or some similar sum.

Medicaid recipients may also be eligible for the Healthy Opportunities Pilot (HOP) program which connects Medicaid recipients to non-medical resources related to food, housing, transportation, and interpersonal safety. This can include: transportation to the grocery store or work, help finding stable, long-term housing, meal delivery, and more.

Although Medicaid expansion will have a resounding impact across the state, it is expected to have the highest impact in North Carolina’s rural counties such as Avery, Watauga, Ashe, and Mitchell. Statistics have indicated that more than 20 percent of non-elderly workers are uninsured in several Western North Carolina counties.

“Medicaid expansion is historical and in a wonderful way,” said Avery County Social Services agent and Adult Medicaid Income Maintenance Supervisor Ashley McKinney. “Many have been advocating for its expansion for years. Medicaid is much-needed by, and even life-changing and lifesaving for so many, particularly residents in the mountain areas of the state. A large increase in the number of people who qualify for Medicaid is expected in these regions. I know all Social Services and Medicaid agents across North Carolina are eager and happy to help as many people get covered as possible. We realize people with health insurance are more likely to get the care they need, and to be protected from high medical and related bills with Medicaid.” 

Call or visit your local Department of Social Services for assistance determining Medicaid eligibility, exploring it options, and enrolling in it.  Social Services agents offer free, unbiased help so others can make the best health insurance decisions for themselves and their families.

Agents can also help those who had their Medicaid terminated during the unwinding period that began in April 2023 determine their current eligibility and possibly get their coverage restored. Before the unwinding period, continuous Medicaid coverage was provided to beneficiaries during the Coronavirus (COVID-19) Public Health Emergency Pandemic. Additionally, Department of Social Services agents can help current Medicaid beneficiaries who are experiencing concerns with their plans.

Medicaid enrollment may also be conducted online by logging onto:  Medicaid.ncdhhs.gov.