300,000 North Carolinians who were able to use government health insurance since 2020 could lose it

As many as 300,000 people in North Carolina could be on track to lose their government health insurance by the middle of next year.  

That estimate comes from the state Department for Health and Human Services, which is preparing plans to check Medicaid recipients’ family, health, and income information to ensure they are eligible for the insurance plan.  

States must begin checking enrollees’ Medicaid eligibility for coverage in April, with the aim of removing those who no longer qualify over the next 12 months.  

Before the COVID-19 pandemic, people who use Medicaid were recertified every year, with information such as income and family size verified to see if they continued to meet qualifications. People who use Medicaid can lose and gain coverage as their incomes fluctuate or family situations change.  

Beginning in March 2020, states were prohibited from cutting people from Medicaid in order to keep people insured during a public health crisis.  

The federal government pays most of the cost for Medicaid. During the months that the federal government told states to stop recertifying Medicaid enrollees, it also gave states extra money to keep people insured.  

As they pressed for Medicaid expansion last year, state health officials told a legislative committee that recertification would be a herculean job. Many of the people who would lose their insurance would likely be in the pool of those who would qualify under Medicaid expansion, state officials said.  

Last year, the legislature made moves toward expanding Medicaid, which would have made about 600,000 people eligible for the insurance. Many are low-income adults without dependent children. Expansion legislation stalled, but it’s possible it could go forward this year.  

North Carolina has 2.9 million people enrolled in Medicaid this month, compared to 2.7 million in March 2020.  

With so many people to verify, many worry that some will lose their insurance by mistake. The job of renewing all enrollees will involve finding people who have moved in the last three years. 

“There’s a big reason for concern about that,” said Doug Sea, a senior litigation attorney at the Charlotte Center for Legal Advocacy. “The word needs to get out.”  The advocacy center is considering hosting a webinar for health care providers “who need to understand what’s happening, what the protections are and where to send people,” Sea said. Medicaid enrollees can also turn to the NC Medicaid Ombudsman for information, he said.  

There is a wide range of people who are most likely to lose Medicaid coverage: those for whom social services departments don’t have accurate addresses; parents or caregivers who no longer have children younger than 18; parents and caregivers whose incomes have increased; and youth who turned 19 or 20 during the public health emergency, according to information Sea provided.  

NC DHHS provided Policy Watch with its preliminary Medicaid unwinding plan late last year, but the timeline is now outdated with the passage of the federal budget. The original intent was to have recertifications begin when the federal public health emergency ended. But the omnibus bill Congress passed in December included a provision that changed that timeline and added state reporting requirements. 

DHHS did not make a Medicaid official available for an interview last week, but sent this statement: 

NCDHHS has been preparing for the massive task of requalifying Medicaid beneficiaries for coverage. We recognize people will lose coverage in this process, but our goal is to ensure people eligible for Medicaid do not lose coverage and those no longer eligible are transitioned smoothly to affordable health plans. We are working with internal teams and county DSS partners to facilitate a fair plan for moving forward and addressing needs that arise. We anticipate submitting the federally required planning documents to CMS by Feb. 15, 2023.” 

Wake County has added 20 temporary staff members to help with the recertifications, said Katie Thompson, the county’s family and children Medicaid intake manager. 

“Recertification isn’t anything new, it’s just that it hasn’t been done in three years,” she said.  

While recertifications were paused, there wasn’t necessarily a reason for all enrollees to communicate with Medicaid offices to report changes in contact information.  

Circulating information about recertification will be critically important while counties are working to verify Medicaid qualifications, she said.  

“It will be a challenge when we get ready to do the redetermination,” Thompson said. It’s important to let enrollees know that if they’ve moved to contact their local Medicaid office, she said.  

More than 200,000 Wake residents are enrolled in Medicaid. Thompson said there’s no way to know how many might lose coverage in recertification.  

The state is working on a plan to reach Medicaid enrollees with information about recertification, but counties don’t yet have anything formal, she said.  

A legal settlement last fall between DHHS and Medicaid enrollees will help prevent people losing their coverage without notice, said Sea, who represented enrollees. For example, enrollees who might no longer be eligible for Medicaid for the original reason they signed up — having a child under 18 for example, could be eligible for another reason. All those other reasons must be checked before insurance coverage ends.  

Under the settlement, the state agreed that Medicaid enrollees should be able to reach social services departments promptly by telephone. North Carolina Health News reported on the settlement in December.  

Under the agreement, busy signals are to be avoided by having calls roll over to an available staff member or having callers be able to leave messages, and have those messages returned promptly. Telephone hold times should be limited, and callers should be able to leave messages after work hours and on weekends.  

States must meet federal requirements for reporting each month how many enrollees are renewed.  

Lawyers who represented Medicaid enrollees will get their own monthly reports on renewals.  

“We will have real-time information on that as this goes forward,” Sea said. 

This story has been updated to clarify that as many as 300,000 people could lose their health insurance.