Initial Medicaid Implementation: North Carolina initially implemented their Medicaid program in January of 1970. The Medicaid program was initially implemented through the Department of Social Services with a contract with the North Carolina Blue Cross Blue Shield. The program was moved to the Health Applications System, a private groups to manage the operations and financial risk. Within a year the contract was canceled after the company experienced financial losses. In 1979 the program was moved under the now North Carolina Department of Health and Human Services and began to be administered by Barbara Matula who would administer the program for 19 years. North Carolina began covering people who did not receive cash assistance in 1987 as the state began to expand services to more groups.
Key Medicaid Political Issues: North Carolina has a low cost and less generous Medicaid program in terms of eligibility. The state ranks 42nd among states in terms of spending per a beneficiary and 40th among states in generosity of benefits. North Carolina uses a county cooperation agreement with the state funding approximately 85% of the state costs and the counties covering approximately 15% of the share of the FMAP. In the early 1990’s the state made several enhancements to eligibility and benefits in addition to enhancing the state’s managed care program. The managed care program was introduced to be statewide by December 2005. The reforms included several efforts to reduce costs through limits on prescription drugs, reductions in physician payment rates and inflationary growth, and a reduction of eligibility through income and asset limits primarily for the elderly and people with disabilities. In 2016 the state took a number of steps aimed at reducing benefits and costs, despite the Medicaid program running under budget, including instituting waitlists for children with disabilities. In 2018 the state received an 1115 waiver for delivery system reform among their hospitals and to improve the care of social determinants of health.
Medicaid Expansion Implementation: North Carolina has yet to expand Medicaid as part of the Affordable Care Act. Until 2015 the state had a Republican controlled legislature and governor. The Democratic Governor has pushed Medicaid expansion but is unlikely to receive votes in the legislature. The legislature has discussed adding a work requirement to the existing Medicaid program which could be used as leverage for negotiations to pass a Medicaid expansion in future years. According to one poll in 2016 72% of North Carolina residents supported Medicaid expansion. Currently, parents must make under 44% of the poverty level to qualify for coverage in North Carolina. It is estimated that approximately half a million people would be eligible for Medicaid expansion.
General facts about North Carolina Medicaid:
Medicaid program name: Medicaid
CHIP Program name: NC Health Choice for Children
Separate or combined CHIP: Combination
Medicaid Enrollment: 2,033,474 (estimate 2018)
Total Medicaid Spending: $13.5 billion (FY 2017 Estimate)
Share of total population covered by Medicaid: 18%
Share of Children covered by Medicaid: 40% (estimate)
Share of Medicaid that is Children and Adults: 72%
Share of Spending on Elderly and people with disabilities: 64%
Share of Nursing Facility Residents covered by Medicaid: 60% (estimate)
Expansion state: No
Number of people in expansion: N/A
Work Requirement: No