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Here's what you need to know about North Carolina's Medicaid expansion

Governor Roy Cooper, a white man in his 60s wearing a black suit and a red tie, speaks at a podium. He's photographed from the side. Standing next to him is Tom Ross, a white man with white hair in his 70s, and Margaret Spellings, a white woman wearing dark glasses in her 60s.
Office of the Governor
Governor Roy Cooper with Tom Ross and Margaret Spellings.

After years of negotiations, Medicaid is finally expanding in North Carolina.

On Monday, Gov. Roy Cooper announced that North Carolina's Medicaid expansion would go into effect on Dec. 1, 2023. Here's what you need to know.

Why now?

This is the culmination of over seven years of work for Cooper. He has been advocating for state Medicaid expansion since the federal government authorized it in 2014. But in order for Medicaid expansion to go into effect, the state legislature needed to approve it. So for the past seven years, North Carolina has been one of the 11 states holding out on Medicaid expansion.

N.C. Republicans have long objected to the expansion of Medicaid. After continuous lobbying from county GOP officials, sheriffs, and other constituents, the party finally started to come around to the idea.

The General Assembly passed a bipartisan bill in March 2023 that would grant Medicaid expansion upon the passage of the next budget bill. Still, there was a lot of stalling on budget negotiations. Republicans made several amendments to the budget, including new rules taking away some gubernatorial powers and a major boost to the state's private school voucher program. Nevertheless, Cooper announced that he'd let the bill become law on Sept. 22.

What does Medicaid do?

Currently, 2.9 million North Carolinians are enrolled in Medicaid. 1.2 million are uninsured. Gov. Cooper stated this expansion would give an estimated 600,000 North Carolinians comprehensive health care coverage, including primary care, maternity care, prescription coverage and other benefits. The N.C. Dept. of Health and Human Services stated that there would be no monthly premiums and no copays over four dollars.

Medicaid does not use state funding — 90% of Medicaid costs are covered by the federal government, and the remaining 10% is covered by hospital assessments and the Prepaid Health Plan (PHP) premium taxes, which health insurance companies in North Carolina pay for.

Who qualifies?

The new rules say that anyone aged 19 to 64 who makes 138 percent of the federal poverty line is eligible. For example, a single person making less than $20,120 a year would be eligible. Those who are eligible for the new rules and enrolled in Medicaid's limited Family Planning Program will be automatically enrolled on Dec. 1.

Applications will open on Dec. 1. Those interested in enrolling can apply on the NCDHHS website or via mail.