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Medicaid expansion starts Dec. 1 in NC. Here’s how Border Belt counties are preparing

By Rachel Baldauf

Medicaid expansion will begin in North Carolina on Dec. 1, opening the door for hundreds of thousands of people who were previously ineligible to enroll.

The Scotland Health Care System in Laurinburg wants to be prepared. The hospital now has three on-site employees dedicated to helping people through the sign-up process, and staff members are compiling a list of patients who may soon qualify for coverage.

The Robeson County Department of Social Services is creating a Medicaid call center to answer questions. About 6,000 people in the county are expected to sign up. 

Educating people about Medicaid expansion is key to increasing enrollment. 

David Pope, the chief executive officer of Scotland Health, said the hospital system employs community health workers who help explain health care coverage options. Still, getting the word out can be difficult. 

“When folks come to our facilities, and we’ve got that connection, then we can make good on that relationship and that connection,” Pope said. “But if folks aren’t having immediate needs for health care, it’s hard.”

North Carolina became the 41st state to expand Medicaid when the legislature passed a budget in September. Under the new guidelines, adults ages 19 through 64 who earn up to 138% of the federal poverty rate may now be eligible for health care coverage through the federal program run by states. Starting Dec. 1, more than 600,000 additional people in North Carolina will be able to apply for Medicaid, according to the N.C. Department of Health and Human Services.

In the Border Belt region of Bladen, Columbus, Robeson and Scotland counties, where more than  20% of residents live in poverty, Medicaid is vital. As of Nov. 7, more than 112,000 people were enrolled in Medicaid in the four counties, data shows

Medicaid-enrolled patients made up 22% of those seen at Scotland Health last year, Pope said. 

Still, many people remain uninsured. More than 13% of residents in Bladen, Columbus, Robeson and Scotland counties were uninsured in 2021 according to data from the U.S. Census. In Robeson County, the figure was almost 17%.

Many uninsured people are simply unaware that they qualify for Medicaid or other financial assistance. In 2021, over 25% of nonelderly uninsured people nationwide were eligible for Medicaid or the Children’s Health Insurance Program, according to KFF, formerly known as the Kaiser Family Foundation. Over 60% of those uninsured and eligible were people of color, and nearly 70% lived in working families.

During the COVID-19 pandemic, the Families First Coronavirus Response Act prevented states from dropping most people from Medicaid. But that provision ended in March, and hundreds of thousands of people in North Carolina were at risk of losing coverage. 

“Health care is a really complicated topic in the United States,” said Dr. Ciara Zachary, an assistant professor at the UNC Gillings School of Global Public Health. “And so when folks maybe lose their insurance, they may think, ‘Oh, I’m no longer eligible.’”

After someone is enrolled in Medicaid, continued education is needed, Zachary said.

“When people haven’t been insured for a long time, there may be some uncertainty about how to navigate the healthcare system so that they’re getting preventative care,” she said.

Still, Pope is hopeful that Medicaid expansion will remove the financial burden of healthcare for many and improve health outcomes in the region.

“I think it’s a measure of trying to get closer to the ideal, which is that your health outcome should not depend on where you live, or what color your skin is, or how much money your family brings home,” he said.

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