Delay in Medicaid expansion impacts North Carolinians needing life-saving treatment
For North Carolinians like 45-year-old DeAnna Brandon, Medicaid expansion can’t come soon enough.
A blood test she received last April prompted a call from her doctor at the Community Care Clinic of Rowan County, who referred Brandon to a hematologist.
“I had just started a new job, and I got home — when she called me, I was at work — and I looked up what hematologist was and it said, 'cancer doctor,'” Brandon said. “And I fell apart. I was like, ‘What are you talking about? I could have cancer?’”
Brandon was diagnosed with multiple myeloma, a type of blood cancer that impacts plasma cells. She said her condition is made even more severe by a pre-existing gene defect. After nearly eight months of chemotherapy twice a week, doctors said she needs a stem cell transplant — and soon.
“I have a myeloma specialist in Charlotte. I've seen him three times — January, April and last week — and each time he said, ‘Please tell me that you can get it done. You need it now,’” Brandon said. “Like in January, I needed it now. In April, I need it now. July – he's saying, ‘It's got to be within the next three months or you may not qualify anymore.’”
Brandon doesn’t have health insurance and said she is waiting on Medicaid expansion before she can receive the transplant. She is one of many North Carolinians whose healthcare has come to a halt while the General Assembly finalizes the state budget.
Gov. Roy Cooper signed Medicaid expansion into law on March 27, but state health officials are awaiting authority from lawmakers before they can begin enrolling new patients. An estimated 600,000 North Carolinians will benefit from Medicaid expansion.
Legislators were expected to deliver a budget by July 1. After missing this deadline, they now say it might be until mid-September when a budget is passed and the North Carolina Department of Health and Human Services can enroll patients using new eligibility guidelines.
Rep. Donny Lambeth (R-Forsyth) said he has received letters from countless North Carolinians who would benefit from Medicaid expansion.
“I had a farmer — a family — whose wife came up to me in the cafeteria,” he said. “She gave me a letter. She said, ‘I was going to your office, but since I saw you, I want you to have this letter.’ And basically, the letter said they didn't have any health insurance, and her husband had had a stroke.”
Lambeth was an early Republican supporter of Medicaid expansion, introducing his first Medicaid expansion bill to the General Assembly almost eight years ago. Before that, he was the vice president of finance at Atrium Health Wake Forest Baptist. This experience, he said, informed his decision to focus on wellness and preventative care in this Medicaid expansion bill.
Beyond providing life-saving healthcare, he said expansion would prevent patients from relying on emergency rooms for primary care needs and bring down the cost of uncompensated care.
“The emergency room is actually the worst place to go when you don’t need to be there with more of a traumatic experience,” Lambeth said. “I was trying to get people to understand, we need to provide more coverage. We need to get them to a primary care doctor, and we need to get them out of the emergency room, which is the worst and most expensive place to go.”
NCDHHS Secretary Kody Kinsley said an average of 348 people a day were sitting in emergency rooms seeking psychiatric care during the last week of July. Meanwhile, 100 hospital beds sat empty across the state. He said Medicaid expansion would unlock these unused resources.
Kinsley also said the department plans to roll out Medicaid expansion on Oct.1, conditional on authority from the General Assembly by Sept. 1. This authority can be granted without a finalized budget, although it would require the passage of a separate bill — something Republicans in the North Carolina legislature have said they will not do.
Kinsley said 9,000 people were rolled off of Medicaid in June, and thousands will continue to be rolled off until the department can begin expansion. He added that the department is prepared to enroll 300,000 individuals on the first day of implementation.
The state must also implement Medicaid expansion before it will receive $1.8 billion in federal funding, which Kinsley said could benefit behavioral healthcare. He estimates the state is missing out on $500 million dollars a month since March 27 while it waits for authority from the General Assembly.
“If our authority is being tied to [the budget] it’s really tying our hands and so letting us move forward would be valuable, just to maximize the benefit of North Carolina,” Kinsley said.
As for cancer patient DeAnna Brandon, she said she can’t afford health care without a job but is unable to work while receiving chemotherapy. She applied for disability benefits in January and said she has yet to hear back.
“Health insurance — if you don’t have a job you can’t get it. So, that’s why I don’t have it. And then our state hasn’t expanded Medicaid. Therefore, I can’t have Medicaid either,” Brandon said. “So, I’m stuck.”
From the time of her diagnosis, doctors estimated she had three years to live. If she’s able to get Medicaid and receive a stem cell transplant, Brandon said she could extend her life by 10 to 20 years.
“I read on the social security website that if they could start the stem cell transplant, once they start it, I automatically qualify for disability and Medicaid,” Brandon said. “But the catch-22 is, the hospital can't start it until I'm approved for disability and Medicaid. So, it hurts even more knowing that if they could just start it, I would have it.”
If the General Assembly does not grant state health officials authority to move forward by Sept. 1, a spokesperson for the state health department said Dec. 1 could be the earliest rollout date, while further delays could stall expansion until 2024.