Medicaid Expansion in North Carolina: April 2024 Updates

“Our partners in this effort helped us form one of the most unlikely bipartisan, cross-industry coalitions ever assembled in North Carolina–and we succeeded.”

— Care4Carolina Executive Director Abby Emanuelson speaking about Medicaid Expansion in North Carolina

Medicaid Expansion is one of the greatest public health achievements in North Carolina’s history, even though it is far from the end of the road toward truly healthy communities across our state. In honor of this week of recognition, we’re providing you with an update on Medicaid Expansion since it went into effect last December.

In this blog post, you can learn about the impact of Medicaid Expansion to date and considerations for oral health access and equity for newly eligible beneficiaries.

NC Medicaid Expansion

To recap, Medicaid Expansion extended coverage to people ages 19 through 64 years old who previously fell in the health care coverage gap, meaning they earned too much to qualify for Medicaid but too little to access the Affordable Care Act marketplace. Since expansion began on December 1, 2023, nearly 400,000 newly eligible recipients have already enrolled (about 1,000 daily), which is over half of the 600,000 expected to enroll over the next two years.

After launching Medicaid Expansion, NCDHHS, county health departments, and local social services departments have enrolled recipients faster than other states in the past (all states had the option to expand Medicaid beginning in 2014). Community-based organizations and partners have been essential in spreading the word and helping people enroll in the best plan to meet their needs.

NCDHHS Medicaid Data Dashboard

The NC DHHS Medicaid Expansion data dashboard provides monthly updates on how many people have enrolled through Medicaid Expansion, including statistics by health plan, demographics, and county. During a January 2024 interview, NCDHHS Secretary Kody Kinsley reported that Medicaid Expansion had already covered over $4.8 million in claims for dental services.

Highlights from the dashboard reports through March 2024 include:

  • New enrollees disproportionately live in rural communities (96,318 enrollees as of March 2024)
  • Over half of enrollees are under 40, with most between 19 and 29 years old
  • Anson, Edgecombe, Richmond, Robeson, and Swain counties have seen the highest enrollment rates

Oral Health Provider Shortage & Access to Care

While we celebrate the milestone achievement of NC Medicaid Expansion, we have more work to do. While North Carolina offers all Medicaid recipients oral health coverage, it is not currently listed as a benefit on the Medicaid insurance cards. Many people, from newly eligible recipients to health directors, remain confused about what Medicaid covers.

We also need more oral health providers who accept Medicaid to meet the growing demand. The physician shortage, especially in rural communities, affects beneficiaries and frontline workers alike. During our 2023 Oral Health Day event, keynote speaker Kathy Colville, former President and CEO of the North Carolina Institute of Medicine (NCIOM), put it clearly: “We have truly amazing and exceptional people holding up an inadequate system.”

Only 28 percent of dentists in North Carolina accept meaningful volumes of Medicaid patients. Of those who do, many accept just a few recipients and are not currently accepting anyone new. A contributing factor to this low acceptance rate is that Medicaid dental reimbursement rates remain at the same level as they were in 2008.

Long before NC Medicaid Expansion, dentists advocated for higher Medicaid reimbursement rates for oral health, which falls around 34 cents on the dollar today. Many more providers need to accept Medicaid to meet the demand. “They [Medicaid providers] are woefully underfunded,” said NCOHC Vice President Dr. Steve Cline.

Some estimates among oral health care providers suggest that reimbursement rates need to be at least 75 cents on the dollar to build an adequate private provider network to meet the need. Our incredible public health oral health providers do not have the necessary time, capacity, or resources to serve every Medicaid recipient in the state.

Unless our state and federal governments commit to a massive expansion of public health funding, we need private practice dentists to begin accepting new Medicaid patients as soon as possible.

What’s Next?

Alongside an overhaul of NC Medicaid reimbursement rates, as we continue to enroll communities across our state, we need to both incentivize and make it economically viable for oral and health care providers to practice in rural areas. One path forward is expanding loan forgiveness options for dental professionals in rural communities.

We must also continue to advocate for policies and programs to expand the use of teledentistry. To do this, we need a robust rural broadband infrastructure.

Last year, NCOHC partnered with the North Carolina Institute of Medicine, with support from The Duke Endowment, to launch the Oral Health Transformation Task Force. Their full report with recommendations to transform our current oral health system will be released to the public soon. Stay tuned for more information!