Medicaid Expansion is Here!

Up to 500,000 People Receiving Benefits Due to Medicaid Expansion.

Up to 500,000 people who are enrolled in Medicaid’s limited family planning program will receive a letter or have received a letter from their local Department of Social Services (DSS) letting them know they will receive full coverage on Dec 1. They will also receive a packet from their health plan that includes a new Medicaid ID card. Additionally, anyone with health coverage through HealthCare.gov will need to cancel their plan once they are enrolled in NC Medicaid.

Medicaid Expansion at a glance

This expansion will allow folks who have not qualified in the past to be eligible for coverage. There is no monthly fee, and copays are never more than $4.

People already enrolled in Medicaid’s limited Family Planning Program who are eligible will be automatically enrolled in full Medicaid expansion benefits.

Coverage includes primary care, hospital services, maternity and postpartum care, vision and hearing services, prescription drug benefits, behavioral health, preventive and wellness services, dental and oral health services, medical-related devices, and other therapies.

Eligibility for Medicaid Expansion

Most people will get health care coverage through NC Medicaid if they:

• Live in North Carolina
• Are ages 19-64
• Are a citizen or a qualifying
  non-citizen

Non-citizens eligible for NC Medicaid must live in North Carolina and be a qualified non-citizen for at least five years. (Refugees, asylees, or legal permanent residents who used to be refugees or asylees are exempt from the five-year wait period.)

Adults ages 19 through 64 earning up to 138% of the federal poverty line (singles earning about $20,000/year or families of three earning about $34,000/year) may be eligible.

How to Apply

The easiest way to apply is online anytime at ePASS.NC.gov–a secure, self-service website that lets you avoid wait times for in-person applications. Completed online applications may also be processed faster.

If you cannot apply online, you can:

• Apply in person at 40 Coxe Avenue in Downtown Asheville.
• Call (828) 250-5500 and complete a telephone application.
• Mail a completed paper application, found at medicaid.ncdhhs.gov, to Buncombe County Health & Human Services, PO Box 7408, Asheville, NC 28801.

Comprehensive Coverage

Medicaid provides comprehensive coverage to all beneficiaries. This includes services such as:

• Primary Care Visits
• Dental Care
• Vision
• Hearing
• Hospital Stays
• Maternity Care

Medicaid pays for doctor visits, yearly check-ups, emergency care, mental health and more, at little or no cost to the patient.

For more information about expanded eligibility for NC Medicaid, go to the NCDHHS website where you will find a toolkit of resources for organizations to spread the word to their communities.

Benefits Come After Long Wait

“This is a historic moment,” says Pisgah Legal’s Chief Operations Officer Jaclyn Kiger. “We have been advocating for Medicaid expansion for more than 10 years, and to see it become a reality is exciting. This will be life-changing and lifesaving for folks in our mountain region.”

Although Medicaid expansion will have a resounding impact across the state, it is expected to have the highest impact in North Carolina’s rural counties. Data from the Georgetown University Center for Children and Families indicates that more than 20% of non-elderly workers are uninsured in eight of WNC’s 18 counties.

“We expect to see a large uptick in the number of people who qualify for Medicaid in this region,” says Kiger. “Pisgah Legal is prepared to help people apply for Medicaid. We know people with health insurance are more likely to get the care they need, and to be protected from crippling medical bills. We are eager to help as many people get covered as possible.”

Free Help from Pisgah Legal Services

Nonprofit Pisgah Legal Services will guide people in western North Carolina (WNC) through the application process. Certified navigators provide free, confidential help to folks who need to understand their options for coverage and help local people find quality, affordable health insurance plans. They offer free, unbiased help so folks can make the best decisions for themselves and their families. Medicaid applications are open year-round.

To make an appointment for free help enrolling in Medicaid or exploring your options, visit www.pisgahlegal.org/medicaid-expansion or call (828) 210-3404.

Pisgah Legal also helps people who have had their Medicaid terminated during the unwinding period that began in April 2023. If you or someone you know has lost coverage, Pisgah Legal can help you determine if you’re eligible for a plan on the Healthcare.gov Marketplace and can help you access legal resources.

Pisgah Legal has a NC Medicaid Ombudsman Program that helps current Medicaid beneficiaries who are experiencing problems with their plans.

Medicaid beneficiaries in all 18 WNC counties may also be eligible for the Healthy Opportunities Pilot (HOP). HOP connects Medicaid recipients to non-medical resources related to food, housing, transportation, and interpersonal safety. This can include transportation to the grocery store or work, help finding stable, long-term housing, meal delivery and more.