More than 400,000 people across the state have signed up for Medicaid since enrollment was expanded four months ago. Macon County is a third of the way to its projected signups.
“This number represents more than two-thirds of the 600,000 people North Carolina expects to enroll over the next two years,” Gov. Roy Cooper’s office stated on April 1. “Since Dec. 1, 2023, North Carolina has enrolled an average of more than 1,000 people per day in Medicaid expansion – a pace faster than other states that have expanded Medicaid.”
Medicaid expansion provides coverage to adults aged 19-64 with incomes up to 133% of the federal poverty level. The fiscal impact summary of the NC law that expanded Medicaid states that 133% of the federal poverty level is an annual salary of $20,120 for an individual or $34,307 for a family of three.
According to the NCDHHS dashboard, as of March 5, the last update, 1,390 Macon County citizens had signed up for Medicaid expansion.
Most of the signups came in the first month, at 983.
“In November during ramp-up and December at launch, the new application load was heavy,” said Macon County DSS Director Patrick Betancourt. “Following those two months, new applications have leveled to a more moderate pace.”
Out of the Macon County signups, 385, or 27.7%, were between 19 and 29 years of age; 365 (26.3%), were between ages 30-39. More women signed up than men in Macon County, 770 to 620.
NCDHHS states Macon’s 19–64-year-old population is 19,410, meaning 7.2% have enrolled. That puts Macon in the middle of the state’s 100 counties, which range from 2.9% to 13.9% of the eligible population signing up.
William Hathaway, CEO of the Asheville-based Mountain Area Health Education Center, said signups have gone very well. Many of the early signups, Hathaway said, were automatically enrolled.
Betancourt said the N.C. Division of Health Benefits did not specify a time frame for when growth would occur.
“It would be reasonable to assume that counties with larger populations and denser market opportunities would see quicker growth than more rural counties like Macon,” said Betancourt, adding the larger areas have more media outlets for advertising expansion, larger hospital systems and more health providers assisting patients with referrals, etc.
Betancourt said the N.C. Office of State Budget Management estimates Macon County will have an 11.5% population increase from 2020 to 2030, so he can see that the 3,300 Medicaid expansion estimate eventually hit.
Hathaway said it takes a lot of work to sign someone up for Medicaid.
“There’s all kinds of anticipated bureaucratic paperwork,” Hathaway said. “Nothing out of the ordinary. I wish it were simpler and not as complicated.”
To manage the increased caseloads, the 2023-24 Macon County budget had three additional Medicaid eligibility positions in DSS to meet the workload. In 2023, DSS worked with county leadership to bring in a dedicated Medicaid trainer.
“This position has been instrumental in both training new staff as well as helping veteran staff keep pace with the myriad of policy changes that regularly occur in Medicaid,” Betancourt said.
Before the state legislature passed Medicaid expansion into law, Betancourt said that initial estimates from the N.C. Division of Health Benefits indicated Macon County could expect “approximately 3,300 Medicaid expansion enrollees.”
“With that estimate, the 1,390 that we have served thus far meets what we anticipated,” Betancourt said. “However, we continue to encourage anyone ages 19-64 with higher incomes who have unmet health care needs to apply – they may be able to receive Medicaid even if they did not qualify before.”
A 2023 count by the Macon County Board of Health estimated up to 6,478 uninsured individuals in Macon County are eligible to be added to the Medicaid rolls.
As far as seeing a difference in healthy outcomes, Hathaway says in the short term, getting kids access to primary care could mean fewer sick days for kids and parents.
“In the short term, you get access to vaccinations for the kids…and then get preventative services over the long time,” Hathaway said. “You keep kids in school, keep parents at work and you’ll see graduation rates improve.”
Hathaway said often, young people don’t get tapped into primary care because they are relatively healthy, so those people should get enrolled.