The 411 on Medicaid Expansion

Since December 1, 2023, more North Carolinians have access to healthcare coverage through expanded Medicaid. After a decades-long advocacy effort, this expansion addresses a critical gap in healthcare access, particularly for low-income individuals and families, ensuring they can receive essential medical services without financial barriers.

The impact on nonprofits will be huge. In addition to greater access to healthcare coverage for community members, expansion opens the door for greater, and different, types of funding for organizations that influence social drivers of health. Since expansion was announced, we’ve gotten several questions about what this might mean.

Consider this blog your intro guide to Medicaid expansion!

We’ll break down what it means for healthcare coverage, how you can better help your organization’s clients and what this could mean for the future of whole-person care.

Key Insight 1: New Eligibility Criteria

Most people in North Carolina can qualify for Medicaid coverage based on specific criteria such as residency, age, citizenship status, and household income within defined limits. The majority of NC residents can get healthcare coverage through NC Medicaid if they meet the criteria below:

  • You live in North Carolina
  • You are age 19 through 64
  • You are a citizen or qualified non-U.S. citizen
  • Your household income fits within the chart below:
Household Size Annual Income
Single Adults $20,120 or less
Family of 2 $27,214 or less
Family of 3 $34,307 or less
Family of 4 $41,400 or less
Family of 5 $48,493 or less
Family of 6 $55,586 or less

Medicaid pays for doctor visits, yearly check-ups, emergency care, mental health and more – at little or no cost to the person receiving care.

Nonprofit Tip: Income requirements are broader than they were before expansion, which means that more people are eligible for coverage – but they may not know it. Nonprofits can educate their communities about Medicaid eligibility criteria, providing guidance and assistance to those who may qualify for coverage but are unaware of their eligibility.

Key Insight 2: Impact on Current Beneficiaries

Current Medicaid beneficiaries with full coverage have not experienced changes, while most Family Planning beneficiaries were automatically transitioned to full Medicaid coverage on December 1. While little has changed for this group, transition can still cause confusion and questions.

Nonprofit Tip: Nonprofits can collaborate with Medicaid recipients to address questions or concerns they may have about potential changes in their coverage and provide support during the transition period. This Q&A guide offers a helpful starting point for review.

Key Insight 3: Expanding Coverage for Vulnerable Populations

Certain non-U.S. citizens with qualified immigration status can now access Medicaid coverage, providing a safety net for individuals and families needing healthcare services. Expansion should also help bring health insurance equity to other groups, like working-age populations with a disability, LGBTQ+, justice-involved, early retirees and more. The expanded eligibility criteria levels the playing field and addresses disparities in healthcare access, further positively influencing health outcomes overall.

Nonprofit Tip: If your nonprofit works with immigrant communities, or any of the groups above, it could be beneficial to familiarize yourself with the expanded guidelines. Nonprofits can raise awareness about Medicaid eligibility within select communities, offering support and assistance to navigate enrollment.

Key Insight 4: Improving Health Outcomes and Equity

Medicaid expansion is expected to enhance health outcomes and promote equity across various demographic groups, particularly in rural areas facing challenges. Addressing disparities in access to care and improving health outcomes leads to healthier communities and a more equitable healthcare system overall.

Nonprofit Tip: Nonprofits can advocate for policies and initiatives that support health equity and work to ensure that underserved communities have access to the resources and support needed to thrive.

Key Insight 5: Economic Benefits and Resources

Beyond health benefits, Medicaid expansion brings economic advantages, including increased revenue, job creation and support for healthcare providers and facilities. Projections suggest expansion could generate up to 83,000 jobs across various sectors, enhancing local economies and community well-being by providing opportunities to increase protective factors like stable employment and financial security. Hopefully expansion supports healthcare professionals too – especially those building clientele in rural areas – creating a win-win for fostering rural access to essential care and local practice and provider support. The economic benefits of Medicaid expansion strengthen communities and support local economies, contributing to greater prosperity and well-being for all.

Nonprofit Tip: Nonprofits can leverage Medicaid expansion to advocate for investments in healthcare infrastructure and workforce development, contributing to economic mobility and resilience in communities.

Nonprofits are the Bridge

By understanding the implications of Medicaid expansion and taking proactive steps to support eligible individuals, nonprofits and community-based organizations in North Carolina can play a pivotal role in improving access to healthcare, promoting health equity, and fostering economic prosperity for all residents.