With the end of a federal rule, hundreds of thousands of North Carolinians could lose health insurance coverage or have their benefits reduced.
That’s according to estimates by the N.C. Department of Health and Human Services of how many Medicaid recipients could be affected by the changes starting in April.
Here’s what you need to know and how to keep your coverage.
Why will some people lose Medicaid coverage?
During the COVID-19 pandemic, states which accepted increased amounts of federal matching funds for Medicaid service costs could not drop people from the Medicaid rolls. Typically, states are federally required to re-certify people enrolled in Medicaid yearly.
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The non-withdrawal requirement ends March 31. For a 12-month period starting in April, more than 200,000 renewals will be initiated monthly, according to a spokesperson for DHHS.
Local social services agencies, tasked with re-certifications, will work on cases based on the beneficiary’s existing renewal date.
Those whose incomes no longer qualify them for Medicaid, or who are no longer parents or caretakers, could be dropped. So could those who don’t complete re-certification.
All told, DHHS expects 300,000 or so people to lose full health care coverage or see a reduction in benefits.
What do I need to do to make sure I keep coverage?
During re-certification, people with Medicaid coverage may receive a letter from their local social services office requesting additional information. These requests may have deadlines.
Be sure to update your contact information with your local social services office, including your mailing address, phone number and email address. This can be updated online by opening an enhanced ePASS account at epass.nc.gov or at your local social services office.
Locate your office by going to ncdhhs.gov/divisions/social-services/local-dss-directory
What will happen to my coverage if Medicaid expansion passes?
This month, after years of stalemates and negotiations, the North Carolina House and Senate announced a Medicaid expansion deal. An expansion bill was approved Wednesday by the Senate and is on its way to becoming law.
If expansion takes effect, health insurance coverage under this federal-state program would increase to all adults with income below 138% of the federal poverty level. Currently, the income limit eligibility for a parent or caretaker is 41% of the federal poverty level. Adults without children have no coverage.
This means many dis-enrolled, or who lost benefits because of re-certification, may need to enroll again.
The exact crossover in timelines between expansion being passed and people being dis-enrolled is not yet clear.
Medicaid expansion under the compromise bill won’t take effect until the state budget becomes law — which is supposed to happen before June 30, 2023, but has sometimes taken much longer or not happened at all — and the federal government approves a start date for expansion.
Once the expansion bill has passed, North Carolina will need to submit a plan to the federal government, according to a DHHS spokesperson. The federal government would then have 90 days to review and approve the plan or request additional information, which would stop the clock. Once North Carolina submits a response to any request for additional information, the 90-day clock would start again.
This means that if an expansion bill passes sometime in March, the state begins the process for federal approval soon afterward and the state approves a budget by late June, expansion and its new income parameters could kick in by July. But this could be delayed further.
What is the state doing to keep people informed?
According to DHHS, the state agency has been working with local social services agencies to contact as many as possible of the 2.9 million people enrolled in Medicaid in North Carolina to explain re-certification as well as inform them about other health insurance coverage options, such as the federal Health Insurance Marketplace.
DHHS said that people will be notified by mail, email and other forms of communication during the re-certification period and that NC Medicaid will hold webinars and post updates on social media.
What do I do if I’m dis-enrolled but later become eligible?
Once expansion kicks in, according to DHHS, there will be a special enrollment period and individuals who were previously dis-enrolled can apply for Medicaid at healthcare.gov or epass.nc.gov, or through their local social services agencies.
The Medicaid expansion bill approved by the Senate Wednesday also allows the state to become a Federally Facilitated Marketplace state, which permits the federal government to determine eligibility if an applicant applies online at healthcare.gov. Re-certifications will be handled by social services, according to DHHS.
A clause in the expansion bill says federally qualified health insurance navigators can enroll people in the federal Health Insurance Marketplace if they’re no longer eligible for Medicaid. If a Medicaid beneficiary loses coverage, their notice includes information on the NC Navigator Consortium and how to contact them, according to DHHS.
These navigators are part of a statewide network that works to provide North Carolinians with information about health insurance and options for coverage. You can call toll free at 1-855-733-3711 to reach them or make an appointment for more help at https://ncnavigator.net/get-help/.