NC prepares for Medicaid expansion challenges

By Jaymie Baxley

Without Medicaid, the majority of Robeson County residents would not have health insurance.

Fifty-four percent of the residents of this rural community, which has a population of 116,530 2020 Census — are beneficiaries of the government-funded program. The county had 63,549 Medicaid enrollees in October, the eighth highest number recorded from all 100 counties in the state.

More are expected to join the ranks after Medicaid expansion comes into force on December 1. The long-awaited measure will increase the state’s income limit for Medicaid, expanding eligibility to hundreds of thousands of North Carolinians who make up 138 percent of the population. federal poverty level or less.

Single adults, a population that was effectively ineligible for coverage before the expansion, will qualify if they earn less than $20,000 a year. The threshold increases by $7,094 for each additional household member, meaning a person with a family of four would qualify if their annual income is less than $41,400.

The expansion will have a particularly big impact in economically distressed areas like Robeson County, where the median household income is less than $37,000. Many people in Robeson who are not currently enrolled in Medicaid have no health insurance.

This year’s national County Health Rankings Report of University of Wisconsin Population Health Institute found that 20 percent of county residents are uninsured, higher than the state average of 13 percent. The report also ranks Robeson as the least healthy county in North Carolina.

The work of managing the expected increase in the number of Medicaid applications in the county will largely fall to the Robeson County Department of Social Services.

Gene Downing, who oversees Medicaid enrollment for Robeson County DSS, said the department has hired more people to handle the workload. The agency is also creating a call center to help residents with questions about eligibility.

“There’s a little bit of fear because it’s a new policy that we’re trying to learn (while continuing) to manage everyone that we already had,” Downing said.

Expansion in the middle of the “denouement”

The North Carolina Department of Health and Human Services knows that local agencies such as Robeson County DSS will play a crucial role in implementing the expansion.

In a letter To County Executives and DSS Directors released Friday, DHHS Deputy Secretaries Jay Ludlam and Susan Osborne acknowledged that “the important work to expand health coverage across our state begins in local DSS offices.” The state, they write, is “focused on providing policy changes, automation improvements, training opportunities and financial support to help counties meet this increased demand.”

Ludlam and Osborne also noted that the expansion comes as local DSS offices handle “relax» of the continued coverage requirement, a federal mandate that prevented states from excluding Medicaid participants from the rolls during the first three years of the COVID-19 pandemic.

Medicaid benefits were automatically renewed as long as the provision was in effect, even if a person no longer qualified for the program. The requirement expired shortly after the end of the federal public health emergency earlier this year, requiring North Carolina caseworkers to verify the continued eligibility of 2.5 million enrollees for the first time since March 2020.

More than 162,000 North Carolinians have lost Medicaid since the state resumed layoffs in June. About 141,955 of those people, or 87 percent, lost coverage between June and October for “procedural reasons,” according to the latest data available from DHHS. Procedural disenrollments typically occur when a local DSS office does not have all the information necessary to verify a Medicaid participant’s current income and household size.

DHHS said the state was making “numerous efforts to reach out to beneficiaries to obtain their information” during the process, including through letters, emails, text messages and automated phone calls. But if a caseworker uses an outdated address or phone number, the recipient may never receive the message.

The state’s remaining 20,183 unenrollment-related disenrollments involve residents who were deemed ineligible for coverage based on criteria that will change once the expansion takes effect.

Many of these people are expected to benefit from Medicaid again as part of its expansion.

Medicaid or Marketplace?

The situation can be frustrating for expansion-eligible people who recently lost coverage.

Some turned to NC Browser Consortium for information. The federally funded organization offers free consultations and support to people in need of health insurance.

“We’ve been helping people affected by the outcome since the beginning of the summer, but there’s still a lot going on in the Medicaid space in North Carolina right now, and that’s been one of our concerns,” said Nicholas Riggs, director of the consortium. . “Is it going to be confusing for people with so many different changes?

“Obviously, at the end of the day, Medicaid expansion is absolutely a good thing in that it ensures that people have access to statewide coverage, are covered by the full benefits of Medicaid and can access doctors and essential services. But I think with so many things happening at once, it can be a little confusing.

To further complicate matters, North Carolina’s expansion date will coincide with the open enrollment period for health insurance plans through the Affordable Care Act. Many North Carolinians may be wondering if they should sign up for insurance now through the Federal market or wait until December 1 to apply for Medicaid.

Riggs, however, does not see the overlapping events as a problem. On the contrary, he says, “they complement each other in a way.”

“People who have heard about Medicaid expansion and want to see if they are potentially eligible (may) find that their income is expected to be higher than 138 percent of the federal poverty level,” Riggs said. “They’ve never explored Marketplace before, so we’re able to help them enroll in a Marketplace plan with, many times, a $0 premium.”

As for people who meet the new income threshold for Medicaid, Riggs said the consortium’s health insurance navigators can “reschedule them for an appointment” to apply for coverage after the expansion launches.

“Having both at the same time has definitely been more work for our staff,” Riggs said. “But in terms of how this helps people across the state, I think both types of coincidence, from our perspective, have increased awareness of both Medicaid and the Marketplace.” We’re able to capture people that we might not have had that outside of open enrollment.

‘A blessing’

Kody Kinsley, director of DHHS, said the state has “all hands on deck” to implement the expansion.

“We’ve been working on this for a long time,” Kinsley said in an interview last week with NC Health News. “Every part of the department is involved and excited about this. »

Among other preparations, DHHS is conducting outreach to soon-to-be-eligible North Carolinians and has strengthened its technology systems to accommodate the anticipated increase in activity when the expansion launches. The agency has also worked to strengthen the state’s provider network to ensure new Medicaid participants have access to care.

On Wednesday, DHHS announced it was increasing the Medicaid minimum repayment rate for behavioral health providers for the first time since 2012. The increased rates, which take effect January 1, will be permanent thanks to $200 million in recurring funds allocated by the General Assembly in this year’s state budget.

The first residents who will benefit from the expansion are those currently enrolled in Medicaid family plans, which offer fewer benefits than traditional Medicaid. DHHS estimates that 300,000 family plan members will be automatically updated to complete coverage.

Another 300,000 people are expected to join the ranks through the traditional application process for Medicaid. Kinsley said this can be done using state resources. ePASS website.

“Getting all your application materials and submitting them will be the quickest way for people to go through the system with all the technology we’ve been able to put in place,” he said.

It typically takes about 45 days for Medicaid to take effect after a person is approved. But Kinsley said the benefits will retroactively cover medical expenses dating back to the first day of the month in which the application was submitted.

“Your doctor can bill us and everything will be taken care of,” he said.

Despite all the work that went into preparing for the expansion, Kinsley didn’t promise a smooth rollout.

“I’m confident that we’re going to have a significant number of people coming forward…that will be larger than what the statewide system performance, to the extent that our staff and our DSS office, can handle in just one time. day,” he said, referring to the state Division of Social Services. “That’s normal for any kind of new launch – any new product launch – that you launch.”

Kinsley likened the state to an Apple store “with a line down the street” waiting to buy the latest iPhone. DHHS, he said, expects to see “full waiting rooms” once the expansion goes live.

But Kinsley says it’s a small price to pay to give working families the “peace of mind” that health insurance provides.

“It’s a blessing for these people,” he said. “I’m so excited to help bring this blessing to 600,000 people on December 1.”