Medicaid Expansion: Ncha's Support For A Healthy North Carolina

The North Carolina Department of Health and Human Services (NCDHHS) has expanded Medicaid to cover more residents, with the goal of improving access to healthcare services. The expansion, which took effect on December 1, 2023, is expected to extend coverage to an additional 600,000 people, including those aged 19 to 64. The NCDHHS has also announced that eligible hospitals will receive payments through the Healthcare Access and Stabilization Program (HASP) to support low-income residents. While the North Carolina Healthcare Association (NCHA) has traditionally supported Medicaid expansion, they have expressed concerns about changes to Certificate of Need (CON) regulations included in the bill. Despite this, the expansion is seen as a positive step towards improving healthcare access and strengthening the state's economy.

North Carolina Department of Health and Human Services (NCDHHS) supports Medicaid expansion

The North Carolina Department of Health and Human Services (NCDHHS) has demonstrated its support for Medicaid expansion through various initiatives and programs. Firstly, NCDHHS has played a crucial role in expanding healthcare coverage to more people in the state. Medicaid, through NCDHHS, covers doctor visits, emergency care, mental health services, prescriptions, and more, with little to no cost to those enrolled. This expansion ensures that vulnerable populations, such as children, the elderly, the disabled, and low-income families, have access to the healthcare services they need.

Furthermore, NCDHHS has launched a Community Engagement Plan and website as part of its Inclusion Connects initiative. This initiative aims to empower individuals with intellectual and developmental disabilities by providing them with greater choices and access to services, enabling them to live, work, and participate in their chosen communities. Additionally, NCDHHS has addressed the issue of medical debt, a burden for many North Carolinians, by developing a Medical Debt Toolkit. This toolkit is based on a successful program implemented by NCDHHS to tackle medical debt and improve access to healthcare.

The department has also shown its support for Medicaid expansion through its participation in roundtable discussions and events. NCDHHS leaders have joined rural health providers and community leaders to emphasize the importance of Medicaid access for rural communities, highlighting the potentially devastating impact of federal funding cuts. Additionally, NCDHHS hosted a livestream fireside chat and tele-town hall to discuss the expansion's impact on rural areas, eligibility, and application processes.

Moreover, NCDHHS has actively collaborated with organizations such as the Care Share Health Alliance, the North Carolina Community Health Center Association (NCCHCA), and the NC Navigator Consortium to facilitate Medicaid Expansion Regional Trainings. These training programs aim to equip health centers and community partners with the knowledge and resources needed to support communities throughout the Medicaid Expansion process. NCDHHS has also implemented the Healthcare Access and Stabilization Program (HASP), providing nearly $2.6 billion in funds to 102 hospitals across North Carolina. This program is a crucial component of the state's strategy to enhance access to care for low-income residents and strengthen the state's healthcare safety net.

In conclusion, the North Carolina Department of Health and Human Services has actively supported and facilitated Medicaid expansion through various initiatives, programs, and collaborations. These efforts reflect the department's commitment to ensuring that all North Carolinians, especially vulnerable populations, have access to affordable, comprehensive healthcare services.

North Carolina Community Health Center Association (NCCHCA) provides training to support Medicaid expansion

The North Carolina Community Health Center Association (NCCHCA) is a non-profit, consumer-governed group of Federally Qualified Health Centers (FQHCs). They provide integrated medical, dental, pharmacy, behavioral health, and enabling services to around half a million patients in North Carolina. The NCCHCA represents FQHCs to state and federal officials and provides training and technical assistance on various issues.

The NCCHCA is committed to providing North Carolina’s Community Health Centers with the services, training, and resources needed to excel in the rapidly evolving healthcare environment. They support health center members with peer learning, robust training programs, health center expertise, and clinical and operational resources.

The NCCHCA provides training to support Medicaid expansion. They are collaborating with the Care Share Health Alliance and the NC Navigator Consortium to host Medicaid Expansion Regional Trainings. These trainings are a two-part series that cover Medicaid 101 content (Part 1) and Medicaid Expansion Outreach, Education, and Enrollment content (Part 2). The purpose of these training courses is to equip health centers and other community partners with the information needed to support communities during the Medicaid Expansion process.

The NCCHCA has also hosted events and discussions focused on Medicaid expansion. For example, they held a joint Medication Assisted Treatment (MAT) Conference with North Carolina Central University in 2024, focusing on cultivating a community response to opioid use disorder. They have also participated in meetings and conferences to discuss Medicaid expansion, including the Primary Care Conference and the "Healthy Opportunities" Hybrid Meeting, which focused on preparing for Healthy Opportunities (HOP) statewide expansion.

The NCCHCA's efforts to support Medicaid expansion are in line with North Carolina's broader strategy to improve access to healthcare for low-income residents. The expansion of Medicaid is expected to benefit an estimated 600,000 people in the state, providing them with full Medicaid coverage.

Medicaid expansion will save lives, improve healthcare, and benefit the economy

Medicaid expansion in North Carolina will save lives, improve healthcare, and benefit the state's economy.

On December 1, 2023, North Carolina expanded its Medicaid program, making healthcare coverage available to more people. This expansion is expected to benefit around 600,000 people, with nearly 300,000 people with limited Medicaid family planning benefits being automatically enrolled on the first day. This move will ensure that people have access to comprehensive physical and behavioral healthcare services in their communities.

Medicaid expansion will save lives by providing healthcare coverage to those who need it most. It will improve healthcare by increasing access to essential services such as primary care, hospital stays, maternity care, vision and hearing services, dental care, prescription drugs, behavioral health, and more. These services will be provided at little or no cost to the beneficiaries, ensuring that financial barriers do not prevent people from seeking necessary medical attention.

Additionally, Medicaid expansion will benefit the economy by sending billions of dollars into the state. For instance, nearly $2.6 billion in funds will be distributed to 102 hospitals across the state. This funding will provide much-needed support to rural hospitals that have been struggling to keep their doors open. By strengthening rural hospitals and health systems, the expansion will improve the overall healthcare infrastructure in North Carolina.

The North Carolina Department of Health and Human Services (NCDHHS) has also taken steps to ensure a smooth transition during the Medicaid expansion. They have implemented policy flexibilities to support both expansion members and providers, ensuring that beneficiaries receive uninterrupted care. Furthermore, NCDHHS is offering training programs and resources to help health centers and community partners navigate the expansion process effectively.

While there has been some opposition to certain aspects of the Medicaid expansion bill by the North Carolina Healthcare Association (NCHA), the overall expansion of Medicaid is supported by the association. They recognize the potential life-saving and healthcare-improving benefits of expanding access to healthcare coverage for North Carolinians.

Hospitals oppose changes to Certificate of Need (CON) regulations

The North Carolina Medicaid expansion bill includes significant changes to Certificate of Need (CON) regulations, which has received strong pushback from the North Carolina Healthcare Association (NCHA), a group that represents North Carolina hospitals. The NCHA has long supported Medicaid expansion, but it does not support changes to the Certificate of Need process.

CON laws are used to restrict the supply of a variety of services. Hospitals cannot simply add more inpatient beds or operating rooms; they must first receive approval from state regulators who determine if there is a need for those services. In North Carolina, CON laws prohibit healthcare providers from acquiring certain medical equipment or developing new health services, health service facilities, and health service facility beds without the prior approval of the Department of Health and Human Services.

The worry from hospitals is that if operating rooms are no longer protected by CON, competitors will open surgery centers and take away market share of these lucrative procedures. These surgery centers will not include emergency rooms or provide other kinds of charity care, leaving those services to be covered by traditional hospitals. It would reduce the charity care burden. Although Medicaid doesn't pay the same rates as private insurance or Medicare, it does contribute something. People without any health coverage still go to hospitals to receive care, often through the emergency room, one of the most expensive areas of a hospital. If North Carolina were to expand Medicaid, it would reduce the number of people without health insurance.

However, research shows that CON laws have failed to achieve their stated goals and have done the opposite of what they were intended to do. While the original hope was that CON laws would restrain healthcare costs, increase healthcare quality, and improve access to care for poor and underserved communities, a large body of academic research suggests that CON laws have instead limited access, degraded quality, and increased costs. CON laws are associated with fewer hospitals, fewer hospital beds, and decreased access to medical imaging technologies. Residents of CON states are more likely than residents of non-CON states to travel further to obtain medical services, and CON laws favor incumbent hospitals in the market for services.

Medicaid expansion will reduce the number of people without health insurance

The North Carolina Department of Health and Human Services (NCDHHS) has recently announced that it will launch Medicaid expansion in North Carolina on December 1, 2023, making an estimated 600,000 people eligible for full Medicaid coverage. This decision is expected to reduce the number of people without health insurance in the state.

Medicaid expansion has been shown to reduce the number of uninsured individuals and improve access to healthcare. In states that have adopted the expansion, the uninsured rate has decreased significantly. Research indicates that uninsured individuals face greater challenges in accessing healthcare, with many delaying necessary treatment or going without preventive care due to cost barriers. Medicaid expansion helps address these issues by providing coverage to those who might otherwise be uninsured, improving their ability to access healthcare services.

The Affordable Care Act (ACA) permits states to expand Medicaid coverage to adults with incomes up to 138% of the federal poverty level. As of 2023, 40 states and Washington, D.C. have implemented this expansion, with North Carolina being one of the most recent additions. This expansion has resulted in dramatic reductions in uninsured rates, with extensive research demonstrating improved health and financial security for those who gain coverage.

The impact of Medicaid expansion on uninsured rates is particularly notable in rural areas. Rural hospitals often operate on thin margins, and the costs of uncompensated care can be financially devastating. Medicaid expansion helps alleviate this burden, as evidenced by a review showing that rural hospitals in expansion states had higher median operating margins (3.9%) compared to those in non-expansion states (2.1%).

While the North Carolina Healthcare Association (NCHA) has generally supported Medicaid expansion, they have expressed concerns about proposed modifications to the Certificate of Need (CON) law. However, the expansion is expected to provide significant benefits to the state's residents, ensuring that more people have access to the healthcare services they need.

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