Mountain Projects: NC Medicaid is not a Welfare Program
The Mountain Projects GetCoveredWNC team of Healthcare Navigators on the stairs of the Governor’s Mansion in Raleigh at a recent event celebrating Healthcare Navigators Month. Clockwise from top right: Program Manager Jan Plummer, Caitlin Quinnett, Jane Harrison, Susan Rose and Savanna Rickman. Unable to make the trip were Marilyn Tollie and Linda Curtis. Donated photo
Since the state expanded Medicaid last December, 479,153 North Carolinians have signed up for full-coverage insurance and are already seeing the benefits.
According to the N.C. Department of Health and Human Services, more than 600,000 NC residents are newly eligible for Medicaid because of the expansion, which has made healthcare visits and medication more affordable for many families. Roughly 500,000 of that number has taken advantage, but a significant number have not.
“Enrollment reticence” may be a result of a misconception about Medicaid being for low-income people only, which may have discouraged people from applying.
“There is a stigma about Medicaid that it’s welfare,” said Jan Plummer, Manager of GetCoveredWNC at Mountain Projects. “It’s not — it’s full coverage insurance with $4 copays and no deductibles. We should have had it 10 years ago.”
Medicaid now covers people ages 19 through 64 years old with higher incomes, which has allowed many to have access to comprehensive healthcare who didn’t qualify previously. This is making healthcare more accessible for many families.
Medicaid is comprehensive healthcare that covers doctor visits, yearly check-ups, emergency care, mental health, preventive and wellness services, dental care, medical-related devices and more. There is no monthly premium payment and copays are never more than $4.
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“Everyone has a right to healthcare,” said Plummer, who has been a health insurance navigator with Mountain Projects since 2013. “There is no shame in it, and you really can save a lot of money.”
Get Expert Help for Free
GetCoveredWNC, a Mountain Projects program, provides free, unbiased information about health insurance options and healthcare resources to the seven westernmost counties of North Carolina.
Navigators like Plummer help clients enroll
in the HealthCare Marketplace and apply for expanded Medicaid coverage, while providing year-round case management for clients. For Plummer, it has been heartwarming to see the impact expanded Medicaid has made on many of her clients.
“[Our organization has] put our heart and soul into expanding healthcare,” said Plummer. “It has been amazing being able to see Medicaid expansion and what’s done for people who haven’t seen a doctor in years. People who need eye care and dental care are finally getting the care they need.”
According to Gov. Roy Cooper’s office, Medicaid has covered more than 1 million prescriptions for new enrollees to treat heart health, diabetes, seizures and other illnesses and has paid for more than $17.9 million in claims for dental services — all since Dec. 1, 2023.
“It’s been lifesaving,” said Plummer. “The gap that we had for so long made it impossible for people to go to the doctor. They may have had healthcare but didn’t have an opportunity to do something that was this affordable. Now people who have not had any kind of preventative care in years can go to the doctor and get the medical treatment they may need.”
Part of what Plummer and her team at GetCoveredWNC do is track Medicaid Unwinding in North Carolina, which is the process in which a state redetermines Medicaid eligibility for people who have not renewed their coverage.
To help prevent their clients from losing their Medicaid coverage, GetCoveredWNC navigators track those who are at risk of losing their coverage and reach out to them before their deadline has expired.
According to Plummer, most disenrollments from Medicaid occur due to procedural reasons, such as a client not renewing coverage within a specific time frame. That’s why having a navigator team like GetCoveredWNC on your side can make a huge difference.
Since North Carolina is a “Determination State,” the Healthcare Marketplace is the determining agency for Medicaid expansion eligibility.
This means that applying for insurance at healthcare.gov will not only determine if someone is eligible for financial assistance to pay for Marketplace healthcare, it will automatically determine if you qualify for Medicaid.
“If the Marketplace determines you’re eligible for Medicaid, the state has to give it to them,” Plummer said.
Most people can get health care coverage through NC Medicaid if they meet the criteria below. If someone was eligible before, they still are.
To be eligible for Medicaid, a person must live in North Carolina, be a U.S. citizen between the ages of 19-64 and must meet the monthly income requirement for your household size, as shown below:
• Single Adults — $1,732 or less per month
• Family of 2 — $2,351 or less per month
• Family of 3 — $2,970 or less per month
• Family of 4 — $3,588 or less per month
• Family of 5 — $4,207 or less per month
• Family of 6 — $4,826 or less per month
Plummer encourages anyone who thinks they may be eligible for Medicaid to call her office and get expert help in the application process.
Appointments are free and applications for Medicaid can be done any time of the year.
To learn more, visit getcoveredwnc.com/ or call 828.452.1447.
Established in 1965, Medicaid is the primary source of health insurance coverage for low-income and disabled individuals and the largest source of financing for the healthcare services they need. In 2014, about 80 million individuals were enrolled in Medicaid, or 25.9% of the total United States population. According to the Kaiser Family Foundation, Medicaid accounted for one-sixth of healthcare spending in the United States during that year.
The federal Centers for Medicare and Medicaid Services (CMS) monitors state Medicaid programs and establishes requirements for service delivery, quality, funding and eligibility standards. Medicaid does not provide healthcare directly. Instead, it pays hospitals, physicians, nursing homes, health plans and other healthcare providers for covered services that they deliver to eligible patients.
The Patient Protection and Affordable Care Act of 2010, also known as Obamacare, provided for the expansion of Medicaid to cover all individuals earning incomes up to 138 percent of the federal poverty level, which amounted to $16,643 for individuals and $33,948 for a family of four in 2017. A 2012 United States Supreme Court decision made the Medicaid expansion voluntary on the part of the states.
