With Medicaid set to expand, here's what you need to know

Medicaid expansion will go live Dec. 1 in North Carolina, giving nearly free health insurance to hundreds of thousands of the state’s working poor.

The state is working out details now with the federal government, which will provide billions of dollars to fund the initiative. But the timetable shouldn’t be impacted by a potential federal shutdown, Gov. Roy Cooper said Monday.

The General Assembly approved the expansion in March, but a go-live date was delayed because the legislature’s Republican majority tied expansion to the state budget. The budget was delayed due to an impasse between lawmakers negotiating the budget. Lawmakers passed that budget Friday, allowing the program to go forward.

About 300,000 people will have health insurance on day one of the program because they’re already enrolled in a smaller Medicaid program that covers family planning. Others will have to apply for coverage, and local departments of social services are preparing to enroll people, North Carolina Secretary of Health and Human Services Kody Kinsley said.

The state will nudge people already enrolled in other benefit programs to apply, Kinsley said, but many people who qualify aren’t known to the state and will need to apply on or after Dec. 1.

Below you’ll find information on eligibility and answers to common questions, largely based on information from the state’s Department of Health and Human Services. The department has a wealth of information about Medicaid online, but much of the information is being updated now that expansion is set to take effect.

The state’s health industry is also preparing for the change, and the N.C.Medical Society said it plans to publish an FAQ for members.

Who will be covered?

Generally, U.S. citizens who live in North Carolina, are 19 to 64 years old and qualify under these annual household income requirements will qualify for Medicaid coverage under the expansion:

• Single adults: $20,120 or less
• Family of two: $27,214 or less
• Family of three: $34,307 or less
• Family of four: $41,400 or less
• Family of five: $48,493 or less
• Family of six: $55,586 or less

What if I make too much money?

If you make more than the income limits above, you don’t qualify. But you might be able to buy a health plan subsidized by the federal government through healthcare.gov.

What will be covered?

Medicaid coverage is comprehensive; most health services are provided at low or no cost. According to DHHS that includes:

• Primary care doctors visit, including routine checkups and when you’re not feeling well
• Hospital visits, both inpatient and outpatient
• Maternity and postpartum care
• Vision and hearing services
• Prescription drugs
• Behavioral health
• Devices and therapies

Do I have to apply?

Most of the 300,000 people already enrolled in Medicaid’s limited family planning program in North Carolina will be moved automatically into full Medicaid benefits because the state already has their information and they qualify under the income thresholds. Those who qualify will get a letter confirming that, as well as a new insurance card. Make sure your contact information with DSS is up to date.

Others can apply on or after Dec. 1 by going online here (click the ePass link), or by going in person to their local Division of Social Services office. The department says online applications will be processed faster. It may take 45 days to process applications, and the department urges applicants to include accurate contact information in case there are questions.

Are non-U.S. citizens covered?

Some noncitizens qualify for Medicaid coverage. To qualify, noncitizens must be living in North Carolina and must wait at least five years after receiving qualified immigration status to receive Medicaid. There are exceptions for refugees and in emergency situations.

Are there monthly premiums or copays?

There are no monthly premiums under Medicaid. Some services have copays, but the highest one is $4.

How do I find a doctor?

New enrollees will be assigned to a health care plan within Medicaid based on a number of factors, including where they live and whether they have particular health needs. These plans will provide lists of providers that are in network. New enrollees will have 90 days to change plans.

I’m already on Medicaid. Does anything change for me?

According to the department, nothing changes if you’re already on Medicaid.