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Medicaid expansion is off to a strong start in NC

ePass, the state’s online system for applying for Medicaid, has seen a 15-fold increase in traffic since expansion launched.
Jaymie Baxley
NC Health News
ePass, the state’s online system for applying for Medicaid, has seen a 15-fold increase in traffic since expansion launched.

By Jaymie Baxley, North Carolina Health News

Nearly 273,000 people were enrolled in Medicaid on Day One of the long-awaited expansion that started Dec. 1, according to data released in late last month by the N.C. Department of Health and Human Services.

Hundreds of thousands more low-income North Carolinians will begin the new year eligible for health insurance under the expansion — a policy change that was a decade in the making.

Expansion raised the state’s long-standing income limit for Medicaid, extending eligibility to adults who make up to 138% of the federal poverty level for their household size. The previous limit was 100%, which prevented many single residents without children from qualifying.

Most of the new enrollees were automatically upgraded from Family Planning Medicaid, an existing limited-coverage program for reproductive health services.

About 7,000 more residents joined the rolls soon after. In a recent interview with NC Health News, DHHS Sec. Kody Kinsley said 280,000 people have received coverage through expansion as of Dec. 12.

Data for December is not yet complete, but the early numbers offer a glimpse into how the state’s Medicaid population might grow in the months ahead. Following are some key takeaways.

Who’s getting coverage?

While the majority of the state’s initial group of expansion enrollees are white, Kinsley said distribution among other races has been “quite equitable” overall.

“It’s on par with, or above, where the state is from a population perspective,” he said.

Black residents, who make up 22.2% of the state’s population, accounted for 38.1% of enrollment on the first day of expansion. Hispanic residents, who represent 10.5% of the population, made up 9% of Day One enrollment.

Kinsley said the early data showed a surprisingly large number of older residents joining Medicaid, with people ages 50 to 64 accounting for 22.3% of new enrollees.

“That was really interesting,” he said. “If you're in that coverage gap and you're not getting health insurance until you're over 50, you've probably been struggling with this challenge for some time.”

Where do they live?

Nearly a quarter of the first wave of expansion beneficiaries live in rural counties, according to geographical classifications used by the N.C. Office of State Budget and Management.

Robeson County, an economically distressed county in southeastern North Carolina, saw the biggest spike in enrollment relative to its size. More than 7,100 residents of Robeson, or 10.5% of the county’s adult population, received coverage under expansion on Dec. 1 — the largest share recorded among the state’s 100 counties.

Other rural counties that recorded high portions of adults enrolled in expansion include Edgecombe (9.5%), Richmond (8.7%) and Anson (8%).

How’s expansion going? 

Despite the huge influx of new enrollees, Kinsley said expansion has gone off without a hitch.

“We've had no technology issues,” he said. “The call center increases that we were seeing are being managed and leveled off. We've had no major issues with long lines.”

ePass, the state’s online system for fielding Medicaid applications, had 15,800 visits during the first 12 days of expansion. That’s up from a monthly average of about 1,000, according to Kinsley.

“We’ve had 15 times our normal volume and haven’t had a hiccup,” he said.

About 600,000 people are expected to eventually receive Medicaid through expansion. This new population of health insurance recipients will likely push down North Carolina’s rate of uninsurance into single digits.

Right now, North Carolina ranks among the states with the most uninsured residents, with 11.1% of residents between the ages of 18 and 64 lacking access to health coverage, according to the U.S. Census. That number is somewhat lower than before the COVID-19 pandemic crisis, during which Congress ordered states not to kick anyone who had qualified off of the Medicaid rolls.

That policy swelled the Medicaid population across the country and pushed down rates of uninsurance nationwide. But for the past eight months, states have been “unwinding” their Medicaid rolls, reviewing eligibility for all recipients — including those who became eligible during the pandemic — and disenrolling those who no longer qualify.

North Carolina’s expansion will reverse that trend somewhat.

More complete data from the first month of the measure should be released in mid-January.

This article first appeared on North Carolina Health News and is republished here under a Creative Commons license.

North Carolina Health News is an independent, non-partisan, not-for-profit, statewide news organization dedicated to covering all things health care in North Carolina. Visit NCHN at

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