Medicaid Expansion in North Carolina: Will it Make a Difference?

by Nicholas Patti

April 1, 2023, Raleigh, NC—The big news this past week is that former President Donald Trump was indicted on criminal charges in New York City related to his hush money payments to porn actress Stormy Daniels in 2016. I consider the criminal case against him in New York City to be entirely garbage, although I will not spend more time discussing this issue. Instead, I will turn my focus to North Carolina, where Medicaid expansion was passed in an historic achievement for the governor, the legislature, and the working poor in this State. However, how much of a difference will this passage really make for the people of North Carolina, in terms of sheer numbers—how many people will now become eligible, how many people are on or off the rolls after all is said and done, for example? The numbers look promising, but not as dramatic as previously reported.

Last year, quoting newspaper sources in Raleigh, NC, on this blog, I estimated that roughly 500,000 people would benefit from Medicaid expansion in North Carolina (“The Mid-terms, Medicaid Expansion in North Carolina, and Other Issues,” Raleigh, NC, 10/17/2022, Now, in 2023, at the time of passage by the NC State legislature, the NC Department of Health and Human Services (DHHS) says the measure would insure roughly 600,000 additional people, according to Heidi Perez-Moreno and Kyle Ingram, reporting for the News and Observer (Raleigh, NC, 3/24/2023, print edition, p. 1A). That number is significant for the State of North Carolina.

There is a caveat, however. At this time, some hundreds of thousands of people stand to lose their Medicaid coverage in North Carolina. This unfortunate development comes from the end of a COVID-era policy in which the federal government temporarily increased funding for Medicaid. This funding and policy restriction ended March 31st of this year. As a result, North Carolina will resume re-certifying people for Medicaid on an annual basis. The North Carolina DHHS expects around 300,000 people to lose their health care coverage or see a substantial reduction in benefits during the next year, according to Luciana Perez Uribe Guinassi, writing for the News and Observer (Raleigh, NC, 3/17/2023, digital edition).

Subtract 300,000 from 600,000. The number you end up with is 300,000 additional people gaining Medicaid coverage in North Carolina, taking into account both Medicaid expansion and the renewal of re-certifying people for the program, including new denials. 300,000 or so additional people receiving Medicaid benefits than in 2022 is significant. This number is less significant than 600,000 people, however. It represents only one-half the previously-projected impact of Medicaid expansion in North Carolina. All told, the new legislation, Medicaid expansion, still would make a difference. Without it, a total of 900,000 people would lack benefits, instead of a net gain of 300,000. There would be a net loss of 300,000, with another 600,000 remaining ineligible. Medicaid expansion still makes a difference in 2023, but with the new federal policy changes and funding cuts, Medicaid expansion will not result in a watershed of new, uninsured people gaining Medicaid health coverage for the first time. That said, 300,000 additional people receiving Medicaid benefits over the next year at a time of federal budget cuts, post-pandemic, is nothing to shake a stick at. I should note that Medicaid expansion in North Carolina comes with its own, additional federal funding to cover the difference, representing federal funding that North Carolina had previously been turning down, before Medicaid expansion.

If you are one of the additional 300,000 people who should receive Medicaid health benefits in North Carolina over the next year, consider yourself lucky. The North Carolina legislature and NC Governor Roy Cooper have your back. You are lucky that you do not count yourself one of the 900,000 people who would otherwise lose their benefits over the next year, or who would remain simply ineligible for the benefit, in the first place. Now, you should have health benefits. You will have access to Medicaid.

North Carolina State Capitol Building
North Carolina State Capitol Building, Raleigh, NC, by JillLang, c. 2019,

There is one more caveat to Medicaid expansion taking effect in North Carolina, however. NC legislators stipulated that it will not take effect until the 2023 state budget passes. This budget is due for this State in June of this year. Writing for the News and Observer (Raleigh, NC, 3/28/2023, digital edition), Dawn Baumgartner Vaughan makes an educated guess that, unlike in previous years, this year’s budget will pass without too much trouble, because Republicans in the legislature are very close to a veto-proof majority, and because the budget contains Medicaid expansion, which has long been a priority for Governor Roy Cooper, a Democrat.

Let us hope the 2023 budget passes without delays, and that Medicaid expansion in North Carolina becomes law, and takes effect.

It should be noted that Medicaid expansion has long been a policy priority of the Governor, Roy Cooper. Its passage represents a victory for him, politically, in particular. “With this bill, more uninsured North Carolinians can avoid financial ruin from unpaid medical bills,” Governor Cooper is quoted as saying in the News and Observer (Raleigh, NC, 3/28/2023, digital edition). “More rural hospitals will be able to stay open, with their jobs.”

Governor cooper continued: “Businesses won’t lose as many good workers to illness or to care for a sick family member,” he is quoted as saying. “…People will have access to more doctors, nurses and mental health professionals because there will be more people who can pay them. It’s clear that this legislation I’m signing today will have a positive effect for all working families, even if they don’t directly get Medicaid” (News and Observer, Raleigh, NC, 3/28/2023, digital edition).

Governor Roy Cooper, campaign file photo

After years of trying, lawmakers in North Carolina passed Medicaid expansion, finally. Republican legislative leaders in NC deserve credit, also, including NC House Speaker Tim Moore and NC Senate leader Phil Berger. The one who really deserves the most praise for seeing this legislation through, however, is Governor Roy Cooper, Democrat. This issue has been one of his policy priorities for several years.

Kudos, once again, to North Carolina elected officials for finally finishing this job. The working poor of North Carolina will thank them.

Now, make sure to pass the budget, so this Medicaid expansion can take effect.

—Nicholas Patti

Raleigh, NC


Additional sources:

This blog:  post, 10/17/2022.

News and Observer, Raleigh, NC:  3/28/2023, digital edition; 3/24-25/2023, print edition, pp. 1A, 7A, 10A; 3/23/2023, digital edition; 3/17/2023, digital edition; 3/16/2023, print edition, p. 3A; 3/12/2023, print edition, pp. 1A, 3A-7A, 18A.