Written by Jamie Baxley
Without Medicaid, the majority of Robeson County residents would not have health insurance.
This rural community is home to 54 percent of the population, or 116,530 people. 2020 Census — Is a beneficiary of a government-funded program. The county had 63,549 people enrolled in Medicaid in October, the eighth-highest total. Records of the state’s 100 counties.
More people are expected to enroll after the Medicaid expansion goes into effect on Dec. 1. The long-awaited measure would raise the state’s Medicaid income limits and expand eligibility to hundreds of thousands of North Carolinians who account for 138 percent of national income. federal poverty level below.
Single adults, who were effectively ineligible before the expansion, will now be eligible if their annual income is less than $20,000. threshold It increases by $7,094 for each additional household member. This means that a family of four would qualify if their annual income was less than her $41,400.
The expansion will be especially impactful 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 on Medicaid have no health insurance at all.
This year’s national tournament County Health Ranking Report from University of Wisconsin Population Health Research Institute Twenty percent of county residents were found to be uninsured. This is higher than the statewide average of 13 percent.The report also states that Mr. Robson Least Healthy Counties In North Carolina.
The task of managing the expected surge in Medicaid applications in the county will primarily be 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 in the process of establishing a call center to respond to residents’ questions regarding eligibility.
“This is a new policy that we’re trying to learn, so I’m a little nervous.” [while still] We managed all the people we already had,” Downing said.
Expand in “Rewind”
The North Carolina Department of Health and Human Services recognizes that local agencies, such as Robeson County DSS, will play an important role in implementing the expansion.
In a letter to county mayors and DSS directors on Friday, DHHS Deputy Commissioners Jay Ludlum and Susan Osborne wrote that “important efforts to expand health coverage across the state are being implemented by local DSS offices. It starts with,” he admitted. They wrote that the state is “focused on providing policy changes, improved automation, training opportunities, and financial assistance to help counties meet this increased demand.”
Mr. Ludlum and Mr. Osborn also pointed to continuing coverage requirements, a federal mandate that prevented states from removing Medicaid participants from their rolls during the first three years of the COVID-19 pandemic. He pointed out that the expansion will take place as the government responds to the “easing” measures.
Medicaid benefits were automatically renewed while this provision was in place, even if you lost eligibility for the program.Requirement will expire soon After the federal public health emergency ends Earlier this year, social workers in North Carolina were forced to check whether 2.5 million enrollees remained eligible for the first time since March 2020.
More than 162,000 North Carolinians have lost Medicaid since the state resumed layoffs in June. According to the report, about 141,955 people, or 87%, lost their insurance coverage for “procedural reasons” between June and October. Latest data available From DHHS. Procedural disenrollment typically occurs when the local DSS office does not have all of the information necessary to verify the Medicaid participant’s current income and household size.
DHHS said the state is making “numerous efforts to keep beneficiaries informed” during the mitigation period through letters, emails, text messages and automated phone calls. However, if the caseworker uses an old address or phone number, beneficiaries may not receive messages.
The state’s other 20,183 termination-related terminations involve residents deemed ineligible for coverage under criteria that will change once the expansion goes into effect.
Many of these people are expected to become eligible for Medicaid again under the expansion.
Medicaid or Marketplace?
The situation could be troubling for those eligible for the expansion who recently lost insurance.
Some people NC Navigator Consortium For guidance. This federally funded organization provides free consultation and support to people in need of health insurance.
“We’ve been helping people affected by mitigation since early summer, but there’s still a lot going on in the Medicaid space in North Carolina right now, and that’s why I’m here,” said Nicholas Riggs, director of the consortium. That’s one of our concerns.” . “Will people be confused if so many changes are made?
“Obviously, in the end, Medicaid expansion is absolutely good in terms of making sure people have access to insurance across the state, are eligible for full Medicaid benefits, have access to doctors and essential services.” But I think there’s probably going to be some confusion because there’s so much going on at once.”
Further complicating matters, North Carolina’s expansion date coincides with the Affordable Care Act’s open enrollment period for health insurance plans. Many North Carolinians may be wondering whether they should sign up for insurance now. federal market Or wait until December 1st to apply for Medicaid.
But Riggs doesn’t see the overlapping events as a problem. On the contrary, “they kind of compliment each other,” he said.
“People hear about Medicaid expansion and want to know if they might be eligible. [may] We found that their incomes are projected to exceed 138 percent of the federal poverty level,” Riggs said. “They have never used Marketplace before, so in many cases Premium can help them enroll in their Marketplace plan for $0.”
For people who meet the new income criteria for Medicaid, Riggs said the consortium’s health insurance navigators will be able to “reschedule” them to apply for coverage after the expansion begins.
“Doing those two things at the same time definitely created more work for our staff,” Riggs said. “But how it helps people across the state, from our perspective, I think those two coincidences have increased awareness of both Medicaid and the Marketplace. We were able to capture people who might not have had this opportunity if we hadn’t had an open recruitment system.”
DHHS Secretary Cody Kinsley said the state is working “all hands on deck” to implement the expansion.
“We’ve been working on this for a long time,” Kinsley said in an interview with NC Health News last week. “Every part of the department is involved in this and we’re excited.”
Among other preparations, DHHS is conducting outreach efforts to soon-to-be eligible North Carolinians and strengthening technology systems to handle the expected surge in activity when the expansion begins. The agency is also working to strengthen the state’s provider network to ensure new Medicaid participants receive care.
On Wednesday, DHHS announced it would increase Medicaid minimum reimbursement rates for behavioral health providers for the first time since 2012. The rate increase, which will take effect on January 1, will be made permanent thanks to a $200 million regular fund allocated by the Directorate. Congress as part of this year’s state budget.
The first residents to benefit from the expansion are those currently enrolled in so-called Medicaid family plans, which have fewer benefits than traditional Medicaid. DHHS estimates that 300,000 family plan members automatically upgraded Fully covered.
An additional 300,000 people are expected to join the enrollment through the traditional Medicaid application process. Kinsley said this can be done using state policy. Epas Website.
“With all the technology that we’ve been able to put in place, getting all the application materials there and submitting it will be the quickest way for people to get through the system,” he said.
It typically takes about 45 days for Medicaid coverage to begin after being approved. But Kinsley said the benefits cover medical costs retroactively to the first day of the month in which the claim was filed.
“Your doctor will bill us and take care of everything,” he said.
Despite all the work that has gone into preparing for the expansion, Kinsley stopped short of promising a seamless rollout.
“I’m confident there will be a large number of people coming forward…It will be greater than the performance of the statewide system as long as our staff and the DSS office can manage everything centrally.” ”, referring to the state Department of Human Services. “That’s normal for any type of new product launch, any new product launch.”
Kinsley likened the state to an Apple store with “lines out in the streets” to buy the latest iPhone. He said DHHS expects to see “some full waiting rooms” once the expansion begins.
But Kinsley believes that’s a small price to pay for the “peace of mind” that comes with health insurance for working families.
“It’s a blessing to these guys,” he said. “We are so excited to be a part of blessing 600,000 people on December 1st.”