Medicaid redeterminations, expansion set to collide in North Carolina

Medicaid eligibility determinations, which recently restarted after a lengthy hiatus during the pandemic, are set to roil the industry, with experts bracing for potentially significant coverage losses.

However, one state may prove a bright spot, as legislators finalize a plan to expand the program in North Carolina. With these efforts underway simultaneously, the state may be able to catch people who would otherwise become uninsured.

Jennifer Baron, senior strategist for policy and product at Cityblock Health, said this overlap has huge implications for addressing health disparities and inequities, as patients of color are set to be disproportionately impacted by the Medicaid redetermination process.

"We're really hopeful that those timelines will align," she said.

Large swaths of Cityblock's patients are enrolled in Medicaid, and they are often some of the most vulnerable patients in the health system. The program is critical in helping those patients access the care they need, Baron said.

Expansion in North Carolina, for example, is projected to help 600,000 people secure coverage, with 180,000 of them in the coverage gap, she said. In that gap, patients typically have lower incomes but make just enough money that they don't qualify for Medicaid or for subsidized coverage on the Affordable Care Act's exchanges.

Baron said the expansion would drive a 30% decrease in uninsurance in the state. Nationwide, the populations that have benefited most from expanded Medicaid are Black patients, young adults and women, particularly women who are of reproductive age, according to a recent analysis from KFF.

Women's health is a key disparity that Medicaid can play a key role in addressing, Baron said. In North Carolina, Cityblock offers a value-based care program for pregnant patients that has grown to include 2,000 people.

"This is a hugely important program for us," she said.

While the state had previously expanded Medicaid coverage for pregnant patients, that additional coverage only lasts for one year postpartum, which could lead many of them to drop out after that extended window, Baron said. Expanded Medicaid will ensure greater continuity of care for this population.

The other challenge ahead, Baron said, is finding people who may have housing insecurity or are otherwise harder to reach with traditional communications. These patients could fall off of the rolls during the redetermination period, even if they still qualify for coverage, because their information is out of date.

She said the process is hard for patients to understand, as many have not experienced eligibility determinations before, and also poses a complex challenge for providers and the states who are undertaking the process. 

"We're trying to get our heads around it," Baron said. "It's confusing for members, plans, providers and the state as well."