New Horizons for Health Care in North Carolina

Medicaid Expansion will bring access and opportunity, opening new doors for progress across the state.

For health care advocates across North Carolina, the first few months of 2023 may have felt surreal. More than a decade of hard work and advocacy from countless organizations and individuals passionate about access to health care has paid off with the North Carolina legislature voting to expand Medicaid.

Medicaid Expansion is a once in a generation investment that will make all North Carolina families healthier while strengthening our economy, and I look forward to signing this legislation soon. – RC
— Governor Roy Cooper (@NC_Governor) March 23, 2023

At FHLI, we recognize the benefits this legislation will bring to hundreds of thousands of people in our state. We are proud of the advocacy efforts so many of our staff participated in, and we are thankful to the organizations and individuals who never wavered in their focus on the individuals and communities across North Carolina that stand to benefit from Medicaid Expansion.

By expanding Medicaid, more than 600,000 North Carolinians will gain access to quality, affordable health care. Working families across our state, including veterans, front-line workers, small business owners, parents, and so many more, will all benefit from expansion.

With an estimated creation of 37,200 jobs, thousands in savings for small businesses, and billions in federal funding brought back to the state each year, Medicaid Expansion will also strengthen North Carolina’s economy, create more resilient communities, and reduce uncompensated care costs.

A Long Road Behind Us

Medicaid Expansion first became an option for states when the Congress passed the Affordable Care Act in 2010. North Carolina, along with many other states, did not pass their own enabling legislation necessary to expand Medicaid. In recent years, many of the states that originally passed have changed course, leaving North Carolina among just 11 states that hadn’t enacted Medicaid Expansion.

In recent years, nearly three quarters of rural hospital closures happened in states that failed to expand Medicaid. Breaking this trend and providing much-needed funding to North Carolina’s rural hospitals will provide vital support to rural communities.

Seven rural hospitals in North Carolina closed since Medicaid Expansion was first on the table in 2010. There is re-building that needs to happen. Medicaid Expansion isn’t the end of the road – it is a huge step in a positive direction that opens doors for new opportunities to build a future where all North Carolinians have access to the care they deserve.

The Work Doesn’t Stop With Medicaid Expansion

The North Carolina Senate amended the Medicaid Expansion bill, tying the legislation to the passage of the state budget. Some parts, such as a provision allowing hospitals to use the Healthcare Access and Stabilization Program (HASP), will become effective immediately. But other parts of the legislation, including the main provision expanding Medicaid eligibility to more than 600,000 North Carolinians, wouldn’t go into effect until the legislature and Governor Cooper agree on and pass a biennial state budget.

This provision ties Medicaid Expansion to many other issues, such as teacher pay, education funding, and taxes. In recent legislative sessions, the budget has proven to be a difficult issue to reconcile. In 2019, the legislature and Governor did not reach an agreement, failing to enact a budget before the end of the year.

At the end of the day, North Carolina is closer to expanding Medicaid than it has ever been. There is reason to celebrate this massive achievement, but it is also important to recognize that there is potential for significant roadblocks to arise between where we are and where we need to be.

Medicaid Expansion will make a massive dent in health disparities, increasing access and equity across our state. However, there will still be hundreds of thousands of uninsured North Carolinians unable to access the care they deserve. Many of those who gain Medicaid coverage will struggle to find providers who accept their insurance, especially for oral health and other specialty services.

FHLI’s Work Will Leverage Medicaid Expansion To Help All North Carolinians

FHLI is well-positioned to continue increasing access and equity across North Carolina. Our programs will use Medicaid Expansion as an opportunity, leveraging the policy as we work directly with rural communities and advocate for systems-level change.

Working directly with providers, NCCARE360 will continue connecting hundreds of thousands of people with the resources they need, enabling a community-oriented, person-centered approach to care in all 100 North Carolina counties.
The Center of Excellence for Integrated Care will continue to find new and exciting opportunities to ensure behavioral health is accessible to everyone by helping health care clinics provide whole-person care.
The North Carolina Oral Health Collaborative will have plenty of work to do. With so many people poised to gain oral health benefits, safety net clinics will face a combination of opportunity and challenge. NCOHC is actively supporting workforce initiatives across the state that will help these clinics grow to meet the need.
FHLI’s Bernstein Fellows and scholars will enter the workforce or continue their careers with new avenues to positively impact communities with limited access to care.
Acting as a convener, the North Carolina Rural Health Association will play an important role in coordinating resources for rural communities across North Carolina.
Results NC’s data collection trainings will prove vital in tracking progress and opportunity as Medicaid Expansion takes effect and impacts North Carolina communities.