North Carolina is expanding Medicaid. What does that mean in the Border Belt?

By Sarah Nagem

North Carolina Gov. Roy Cooper has signed Medicaid expansion into law, ending years of partisan debates and promising health care coverage for hundreds of thousands of people across the state. 

Rural regions, including the Border Belt counties of Bladen, Columbus, Robeson and Scotland, are expected to particularly benefit from the expansion. Medicaid, a federal program run by states, helps cover health care costs for poor adults and children, pregnant women and people with disabilities. 

Here’s what to know about Medicaid expansion, which will not go into effect until Cooper, a Democrat, and the Republican-led General Assembly reach a budget deal. 

Who will become eligible for Medicaid under the expansion?

More than 2.9 million North Carolinians – over a quarter of the state’s population – are currently covered by Medicaid, according to the state Department of Health and Human Services

The percentage of residents enrolled in Medicaid is higher in the Border Belt. In Robeson County, the figure is 56%. 

An additional 600,000 people across the state will be eligible for Medicaid under the expansion, according to DHHS. That includes more than 23,000 people in Bladen, Columbus, Robeson and Scotland counties, according to a 2019 report from the Cone Foundation

Here’s a breakdown:

Under the expansion, every adult with an income up to 138% of the federal poverty rate will qualify for Medicaid. That amounts to an annual income of $20,120 for one person and $41,400 for a family of four. (Go here for more calculations based on household size.) 

How will Medicaid expansion affect access to health care?

Many people without health insurance wait until they are severely ill before seeking treatment, often at hospitals' emergency departments.

Experts say expanding Medicaid to more residents will lead to more preventative care – an issue of particular concern locally.

Robeson ranks last among North Carolina's 100 counties when it comes to health outcomes such as quality of life and premature death, according to County Health Rankings published by the University of Wisconsin Population Health Institute. Scotland County is No. 98, the rankings show, and Columbus and Bladen counties are 91st and 85th, respectively.

What will Medicaid expansion mean for local health care providers?

Rural hospitals typically serve a disproportionate number of patients who are uninsured or underinsured

UNC Health Southeastern in Robeson County provided more than $63.2 million in uncompensated care in 2020, according to the North Carolina Healthcare Association. 

Although Medicaid typically pays health care providers less than private insurance companies, they will receive some compensation when residents newly enrolled in Medicaid seek care.

Expanding Medicaid could lead to more health care providers in rural areas, said state Rep. Jarrod Lowery, a Republican who represents Robeson County.

It can be tough, Lowery said, to recruit medical specialists such as endocrinologists to rural counties. But compensation from Medicaid payments could be an incentive. In turn, residents benefit.

“If we have those specialists in our county," Lowery said, "we can provide even better care.” 

Will Medicaid expansion help combat the opioid epidemic?

Health officials say yes.

Without health care coverage, it can be tough to get treatment for substance use disorders. Medicaid expansion will help alleviate that barrier.

But there are other hurdles, said Bart Grimes, chief of behavioral health services at Robeson Health Care Corporation. Medical providers who currently don't accept Medicaid will have to go through a process to get on board.

And while the expansion might help lure health care workers, Grimes said there aren't enough mental health providers to fill the need.

“It will be a lag," he said. "There will probably be people who seek services who won’t get it.”

Why is Medicaid expansion happening now in NC?

Democrat and Republican lawmakers have been squabbling over Medicaid expansion for more than a decade, since it became part of the Affordable Care Act under President Barack Obama.

Until this week, North Carolina was one of only 11 states to have not expanded the program.

Republican lawmakers said they warmed to the idea of Medicaid expansion last year.

State Sen. Danny Britt, a Republican who represents Hoke, Robeson and Scotland counties, told the Border Belt Independent in May that it all came down to money: There was a promise of more than $1 billion from the federal government to states that had not yet expanded Medicaid.  

“The facts now are different than what the facts were two years ago,” Britt said at the time.

What happens now?

We wait for a new state budget.

Once Cooper and the General Assembly agree on a spending plan, Medicaid expansion will go into effect soon after.