In a significant move aimed at improving healthcare access for low-income individuals, North Carolina has officially implemented Medicaid expansion. Governor Roy Cooper signed the expansion law on March 27, 2023, making North Carolina the 40th state to adopt this government-run health insurance program.

For years, the state's Republican-controlled legislature had rejected Medicaid expansion, a key provision of the Affordable Care Act introduced during President Obama's administration. Critics of the expansion, often referred to as "Obamacare," voiced concerns about the financial burden it would place on the state.

One of the major concerns raised by State Senate leader Phil Berger was whether the federal government would fulfill its promise of covering 90% of the medical costs associated with the expansion population. Currently, for existing Medicaid recipients in North Carolina, the federal government only covers two-thirds of medical costs, with the state covering the rest. However, over time, Berger became confident that the federal government would uphold its commitment.

Notably, North Carolina's Medicaid expansion does not include a work requirement, unlike some other states. After assessing the newly eligible population, Berger determined that the majority of these individuals already worked at least 30 hours per week.

The implementation of Medicaid expansion also comes with additional financial incentives from the federal government. Under President Biden's administration, North Carolina hospitals are receiving $2.6 billion, while the state legislature is investing $835 million in behavioral health, including the first reimbursement rate increase for behavioral health services in over a decade.

Health advocates welcomed the long-awaited expansion, which they believe will greatly benefit the community. The Health Advocacy Project of N.C. Justice Center, a liberal-leaning think tank and advocacy group, has organized numerous community events to raise awareness about the expanded eligibility and help eligible individuals enroll in Medicaid.

With the implementation of Medicaid expansion, North Carolinians between the ages of 19 and 64, who earn up to 138% of the federal poverty line, now qualify for Medicaid coverage. This expands coverage to single adults earning less than $20,000 per year and families of three with a combined income below $34,000. Previously, full Medicaid coverage in the state was limited to low-income residents who were disabled, elderly, children, pregnant individuals during the first year of a child's birth, and some very low-income parents.

Governor Roy Cooper emphasized the positive impact of Medicaid expansion on the state's healthcare system and economy. He called it a "monumental achievement" that will provide better healthcare, including mental health and substance abuse disorders, stabilize struggling rural hospitals, and contribute billions of dollars to the state's economy.

The implementation of Medicaid expansion in North Carolina sets an example for other southeastern states considering similar measures. However, despite the positive outcomes observed in North Carolina, some states remain resistant to expansion. South Carolina Governor Henry McMaster's opposition to expansion remains unchanged, while advocates in Tennessee are using North Carolina's success as a case study to push for expansion.

As North Carolina takes this step towards improved healthcare access, advocates hope that more states will recognize the benefits of Medicaid expansion and follow suit. While there are still 10 states, primarily in the southeast, that have yet to expand Medicaid, the success of North Carolina serves as a testament to the positive impact it can have on healthcare and the economy.

In the coming days, North Carolina will continue its efforts to enroll eligible individuals in Medicaid, ensuring that more residents have access to essential healthcare services.