News & Opinion

A Look at Medicaid Numbers After December Expansion in North Carolina

A doctor takes a patient's blood pressure, Medicaid expansion
Medicaid expansion took effect in North Carolina on Dec. 1, 2023. (Photo courtesy of StarMed)

More than 311,000 people in North Carolina have been enrolled in Medicaid since its expansion was implemented in the state in December 2023, Gov. Cooper announced during a celebration of the expansion in Raleigh on Wednesday. 

That brings the total number of Americans nationwide who have benefited from Medicaid expansion under the Affordable Care Act to a record 20 million, Cooper claimed. 

“Medicaid expansion is changing North Carolina for the better, already improving the health of our communities, particularly in rural areas,” said Debra Farrington, N.C. Health and Human Services deputy secretary for health equity, in remarks following a conversation between Cooper, health care navigators and outreach specialists. 

“Hundreds of thousands of people are now receiving comprehensive health coverage through Medicaid expansion and accessing critical health care services, like going to the doctor when they are sick, having regular check-ups, getting regular screening for things like breast cancer or heart disease and can now afford their medications,” she continued. 

A 2017 brief from KFF, an independent, nonpartisan source for health policy research, polling, and news, notes that the nearly 52 million nonelderly people living in the most rural counties in America face the most significant disparities in health care access. Rural residents are less likely to be in the labor force, more likely to have a disability, and more likely to be in a lower income level than urban and other area populations.

Learn more: NCGA Republicans Reach Medicaid Expansion Deal, but Governor Questions Timeline

Seventy-eight of the state’s 100 counties are considered rural, according to the North Carolina Rural Health Association’s (NCHRA) 2023 Rural Health Snapshot, which defines a rural county as one with an average population density of 250 people per square mile or less. 

Twenty-six of those counties received the worst health score on a scale of 1-100 by County Health Rankings & Roadmaps based on health outcomes, behaviors, care access, social and economic factors, and physical environment.

According to NCHRA, 11.4% of North Carolinans — roughly 1.16 million people — did not have health insurance in 2022. Rural residents are 40% more likely to be uninsured.

According to Cooper, 311,000 people in North Carolina had signed up for Medicaid expansion as of his speech on Jan. 10. A dashboard launched by the state health department tracks monthly enrollment. The tool offers a detailed overview of enrollment trends in newly eligible adults ages 19-64 who can now apply for full health care coverage.

The expansion took effect on Dec. 1, 2023, with about 273,000 people enrolling the first day — most of whom were previously part of family planning and were automatically moved to full coverage. The state said about 600,000 people in North Carolina are still eligible to benefit from the expansion, which is ongoing. North Carolina residents eligible for Medicaid under the expansion can apply for coverage at any time.

“We … encourage everyone to check to see if they qualify for Medicaid or Marketplace Insurance under the Affordable Care Act to make sure they have the health care coverage they need,” Cooper said Wednesday. 

Registration for the Affordable Care Act Marketplace ended Jan. 16 for coverage by Feb. 1. Marketplace plans are through private insurers where enrollees pay for their plans, often through federal assistance while Medicaid is a combination of state and federal funds run through the state at little to no cost to enrollees, according to an NCDHHS representative.


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