WS Chronicle

By Tevin Stinson

The Chronicle

In 2023, North Carolina became the 40th state to expand Medicaid, extending coverage to individuals ages 19 to 64. So far, nearly 650,000 North Carolinians have enrolled. While enrollment numbers have exceeded expectations, thousands of people in Forsyth County who are eligible still haven’t taken advantage of this opportunity to get affordable health care coverage.

What We Know

Approved by the N.C. House of Representatives by a vote of 92-22, House Bill 76 established a program called NC Health Works to expand Medicaid to people earning up to 133% of the federal poverty level.

Before the bill—titled “Access to Healthcare Options”—was passed, only individuals with disabilities, those over the age of 65, pregnant women, and those meeting income eligibility limits qualified for Medicaid in North Carolina. This left many adults in a coverage gap.

North Carolina is now the 40th state to expand Medicaid. Former Gov. Roy Cooper called the bill a step toward a healthier state.

“Medicaid expansion is a once-in-a-generation investment that will strengthen our mental health system, boost our rural hospitals, support working families and so much more,” Cooper said in a press release after signing the bill into law.

Though Democrats had long pushed for Medicaid expansion, it was Republican Sen. Donny Lambeth of Winston-Salem, a retired hospital administrator, who introduced H.B. 76. Lambeth has advocated for expansion since taking office in 2017.

When addressing his colleagues about the bill in 2023, Lambeth said it was the most important action they could take to improve quality of life for North Carolinians.

“Health insurance is very expensive, and I think this is one thing we can do that will truly make a difference,” Lambeth said. “I’ve continued to push this notion that we can make North Carolina a better state if we move forward in improving access to care.”

In addition to expanding Medicaid, H.B. 76 also funds a workforce development program offering job training and career readiness resources, and allocates $4 million to county departments of social services to support implementation. Amendments to the bill also include $50 million to help counties certify Medicaid eligibility and cover health care for incarcerated individuals. A separate provision establishes a pilot program to recruit medical providers to rural areas through special loans and loan forgiveness.

You May Qualify for Coverage

In Forsyth County, 116,562 people are enrolled in Medicaid—including more than 25,000 new enrollees. But according to Jonelle Berky, director of Forsyth County Medicaid Services, an estimated 17,000 eligible individuals in the county have yet to enroll.

Berky said Medicaid access can help underserved communities shift from “reactive care” to preventive care.

“We know when folks receive reactive care, there is already sickness there, and when you’re looking at chronic sickness, you’re looking at possible deaths,” Berky said in an interview with The Chronicle.

“Seven out of 10 die from chronic illness because oftentimes that chronic illness was treated reactively. We want to get the Medicaid out there so our communities can be proactive.”

You may be covered under H.B. 76 if you are a U.S. citizen between ages 19 and 64 and earn up to 138% of the federal poverty level—for example, about $1,730 per month for a single individual or $2,970 per month for a family of three. Coverage includes services such as primary care, hospital stays, maternity care, vision and hearing, dental care, doctor visits, yearly checkups, emergency care, and mental health services.

Charles Terry, a recent Winston-Salem State University graduate and former men’s basketball player, is now employed as an eligibility specialist with the county and falls within the newly covered age range. He’s working to raise awareness among his peers.

“A lot of people, especially my age, don’t know a lot about Medicaid, and we’re not taking advantage of the resources that we have,” Terry said.

Get It While You Can

Though hundreds of thousands have benefited from expansion, Medicaid’s future could be in jeopardy. House Republicans have proposed major cuts to Medicaid funding.

In February, the Energy and Commerce Committee, which oversees Medicaid, was directed to cut spending by $880 billion over the next decade.

North Carolina isn’t the only state exploring rollbacks. Eight other states are also considering changes in response to former President Donald Trump’s federal spending cuts. According to NC Health News, the federal government currently pays for about 90% of the cost for patients covered under expansion, with hospitals covering the remaining 10% through a special tax assessment.

Nearly 40% of the program’s beneficiaries in North Carolina live in rural counties—areas that would be hit hardest by potential reversals. In some cases, it could lead to hospital closures.

When asked whether she was concerned about expansion being reversed, Berky said her focus is on the present.

“I’m worried about the here and now. I’m worried about folks that are in this community that are possibly eligible that have not applied. That’s my concern,” she said.

“Am I concerned with federal cuts and how it’s going to affect this community? Absolutely. But what we’re saying is, our main focus is: we have the access now, and we want folks to come in and take advantage of it.”

How to Apply

You can apply for Medicaid online or in person at the Forsyth County Department of Social Services.

To apply online, visit https://epass.nc.gov. Applicants will need to create an NCID—a secure online user ID and password to access government services.

In-person applications are accepted at the Forsyth County Department of Social Services, located at 741 N. Highland Ave., Monday through Friday from 8 a.m. to 5 p.m. No appointment is necessary.

For more information, call (336) 703-3800 or the NC Medicaid Contact Center at (888) 245-0179.