After 1 year, Medicaid expansion in North Carolina nears its enrollment goal

GREENVILLE, N.C. -- Enrollment in North Carolina’s new Medicaid coverage for low-income adults has nearly reached the state's goal of 600,000 in half of the time initially projected, Gov. Roy Cooper said on Wednesday while celebrating the one-year anniversary of expansion in the state.

As of Wednesday, 590,331 people were enrolled in Medicaid expansion in North Carolina, according to the Division of Health Benefits. At the expansion's start on Dec. 1, 2023, Cooper’s administration had estimated the state would reach 600,000 within two years.

Speaking in Greenville with leaders of East Carolina University’s health care system and medical school, Cooper recognized expansion and other health care initiatives advanced during his two terms as governor. Cooper, a Democrat prevented from seeking reelection due to term limits, leaves office at the end of the month.

“For the last eight years, we’ve worked hard to lead our state with one health care innovation after another that will leave lasting impacts on generations of North Carolinians to come,” Cooper said in a news release.

Since taking office in early 2017, Cooper was a strong advocate for North Carolina accepting through the 2010 federal Affordable Care Act full health benefits coverage for some adults ages 19-64 who earn too much to qualify for traditional Medicaid.

Republicans in charge of the General Assembly opposed the idea for years. As Congress offered states additional financial incentives to participate, the GOP-controlled legislature and Cooper ultimately enacted an expansion law in 2023, making North Carolina one but a few Southern states to date to accept the coverage. The federal government pays 90% of the cost of expansion, with the remainder paid in North Carolina by an increased assessment on hospitals.

Nearly 273,000 people, most of whom had been receiving Medicaid for family-planning coverage alone, were covered on the first day of North Carolina enrollment.

Over one-third of the expansion enrollees are from rural areas, Cooper's office said, and expansion recipients in the past year have been able to fill 3.8 million prescriptions and have covered $58 million in dental services. Overall Medicaid enrollment statewide is now at 3 million.

Cooper's office billed the event as the first in a series this month to highlight the departing governor's accomplishments.

The news release mentioned a first-of-its-kind initiative this year that will give almost 100 hospitals higher Medicaid payments if medical debt of low- and middle-income patients is relieved and they implement policies that prevent liabilities for future patients. It also cited $835 million — the result of a Medicaid expansion incentive from Washington — appropriated last year for mental health treatment and resources.