In rural parts of the state, patients often struggle to simply get to a doctor's office. It's something Irena Johnson, a community health worker in Ahoskie — a small community in northeastern North Carolina — knows firsthand. She helps run a mobile health clinic.
"The thing that stands out to me the most is transportation," Johnson said. "We have a lot of patients that lack transportation, so they can't get into the doctor's office. So, we are able to go out to them."
Medicaid covers the cost for certain transportation, including medical transport. That has providers in rural areas particularly excited about Medicaid expansion, which North Carolina legislators passed — and Gov. Roy Cooper signed — into law earlier this year. The move will bring health insurance to some 600,000 low-income North Carolinians beginning Dec. 1.
In the Triangle or Charlotte, patients can call up a rideshare app. Johnson laughs at that notion for Ahoskie, a town of 5,000 residents in North Carolina's inner banks.
"There's nothing like that here," said Johnson. "No, there's no Uber, there's no Lyft. No. You either have a car, or you're walking — or the mobile unit's coming to you."
Inside, the mobile clinic looks — well — just like a doctor's office. It has one of those padded patient chairs common in physician offices everywhere.
On a recent morning, Johnson prepped an inflatable armband to read blood pressure. The mobile clinic also has a wheelchair lift for patients who might struggle up the narrow steps. This mobile clinic, run by Roanoke-Chowan Community Health Center, provides an important service in the region. Now that Medicaid will expand, the health center hopes to bring care to even more people.
The health center’s CEO Kim Schwartz said she expects to see a knock-on effect of people realizing they now qualify for Medicaid, similar to what she saw when the Affordable Care Act first passed.
"Just the woodwork effect of when the ACA started, we saw an increase in Medicaid eligibility because folks (realized), 'Oh I might be eligible,'" Schwartz said. "That was just the woodwork effect from that standpoint when that happened back in 2008 and 2009."
Until now, North Carolina had not expanded Medicaid. That’s meant providers have missed millions of dollars in annual revenue they would have received, mostly from the federal government. Cost of care for many of the patients in the coverage gap has fallen to doctors and hospitals who provide that care for free, or at reduced prices. With the added revenue, Schwartz said providers now hope to re-invest that money to bring care to those who will still be without health insurance coverage.
"Yes, we'll see an uptick, and yes it'll have an impact," Schwartz said.
As a Federally Qualified Health Center, Roanoke-Chowan sees patients who fell in the coverage gap. Already they've been screening those patients to see if they qualify for Medicaid. If they do, they help them fill out the paperwork to enroll.
Not far from Ahoskie, physician assistant Al Goddard runs Colerain Primary Care, one of the community health center’s five sites. His clinic helps patients as much as they can, but if they need to refer a patient to a specialist, or recommend more extensive care, he says he knows he's recommending treatment that's cost prohibitive for many people.
"When a person has a choice between, 'Do I pay the light bill and buy groceries, or do I buy medicine? I got to do one or the other.' And there's still people that are facing those kind of tough choices," Goddard said.
For the hundreds of thousands of North Carolinians who will gain access to Medicaid health insurance, Goddard says it could mean the difference between life and death.
"At least they can now get their regular lab tests. They can come in regularly for their office visits," he said. "They have a chance now."
Across the state, that's the perspective of many providers, who plan to re-invest the additional Medicaid revenue to improve health outcomes, according to Heath Secretary Kody Kinsley.
"We've got to invest our resources in what we know drives health," Kinsley said. "We've been doing that in the department in food and in other social determinants of health. But it also means primary care providers and behavioral health that help drive down costs and improve health across individuals for their life span."
Kinsley added the state health department is prepared for the influx of applications and plans to get people enrolled quickly.