North Carolina Still Has a Coverage Gap
What is the Coverage Gap?
Estimates indicate 244,000 uninsured North Carolinians fall in the Medicaid Coverage Gap and as many as 400,000 would benefit from extending Medicaid coverage. Additionally, there are more than 100,000 uninsured children in North Carolina, and closing the Coverage Gap could greatly reduce that number since children are more likely to get covered and stay covered if their parents gain access to insurance coverage. In 2015, 41% of all FQHC patients in North Carolina were uninsured, and more than 70% of patients lived at or below 100% FPL. Community health centers served 177,088 uninsured adults in 2015, and the majority of those fell in the Medicaid Coverage Gap. Our providers see firsthand the significant health challenges and barriers to needed services that these patients face. In North Carolina, nearly 40,000 women are not receiving recommended preventive screenings, 27,044 diabetics cannot get much needed medications, and 45,500 individuals with depression are not getting the treatment they need. In fact, community health center providers often have to modify treatment plans for uninsured patients because of the patients’ inability to afford a specialist visit or pay for needed medications.
Under Medicaid expansion, outpatient providers could address many of the currently untreated issues that often result in patients seeking inefficient, costly, and inappropriate care in the emergency department. Within the first year of closing Michigan’s Coverage Gap, more than half of expansion enrollees saw a primary care doctor and 17 percent received preventive services. In Kentucky, 46,000 people were screened for diabetes and 13,000 people were treated for substance use disorders within the first year of expansion.
In partnership with the Health Access Project, we have collected stories from CHC patients and assembled a Close the Gap Storybook.
Click here to download and view the storybook.
Here’s how you can help
Show Your Support for Closing the Coverage Gap!
North Carolina could help as many as 400,000 North Carolinians who lack access to affordable health insurance. Federal funding is set aside to provide insurance to this population.
Learn More: NCCHCA Coverage Gap resources
Research and Analysis
- Changes in Utilization and Health Among Low-Income Adults After Medicaid Expansion or Expanded Private Insurance (August 2016): This study the Commonwealth Fund compared two Medicaid expansion states and one non-expansion state and found that regardless of how the state chose to expand insurance coverage for low-income residents (traditional Medicaid expansion vs. private insurance option), doing so increased access to primary and preventive care, reduced emergency department visits, and improved reported health ratings among the newly insured population.
- Medicaid Works in North Carolina (July 2015): This fact sheet from the Center for Budget and Policy Priorities provides a wide range of NC-specific, Medicaid data, including the number and types of individuals served, long-term benefits for children, and Medicaid and private health insurance comparisons.
- Missed Opportunities: The Consequences of State Decisions to Not Expand Medicaid (June 2015)
- Monitoring the Impact of Health Reform on Americans Ages 50–64 – An analysis by the AARP Public Policy Institute and the Urban Institute found the percent of uninsured individuals aged 50-64 years fell nearly a third, from 11.6% to 8.0% between December 2013 and December 2104. Not surprisingly, the drop in uninsured rates for this population was much greater in Medicaid expansion states than in non-expansion states.
- Medicaid Expansion, Health Coverage, and Spending: An Update for the 21 States That Have Not Expanded Eligibility – A new analysis from the Kaiser Family Foundation
- How the Coverage Gap Affects North Carolina Families – This fact sheet by the NC Health Access Coalition shows how working families may fall into the coverage gap.
- Medicaid Expansion Is Producing Large Gains in Health Coverage and Saving States Money (April 28, 2015) - A new report by the Center on Budget and Policy Priorities highlights a number of states which experienced savings as a result of expanding health insurance coverage to the Medicaid expansion population. These states experience greater reductions in uninsured individuals, lower hospital uncompensated care costs, savings on state programs and services to uninsured populations, and greater revenues from plan coverage.
- States Expanding Medicaid See Significant Budget Savings and Revenue Gains (April 2015)
- The Effects of the Medicaid Expansion on State Budgets: An Early Look in Select States (March 2015)
- How Closing the Coverage Gap Benefits Hospitals – This policy brief by Community Catalyst highlights the impact of the Coverage Gap on States choosing not to increase insurance coverage to the gap population.
- The Economic and Employment Costs of Not Expanding Medicaid in North Carolina: A County-Level Analysis — Authored by researchers at George Washington University in Washington, D.C., the study includes data for all 100 North Carolina counties, and concludes that nearly 500,000 currently uninsured residents could gain coverage if the state expands its Medicaid eligibility requirements. The report shows that by 2020 the North Carolina workforce could grow by more than 43,000 jobs, and the state’s economy could gain tens of billions in business revenue if the state expands Medicaid eligibility requirements.
- What Is the Result of States Not Expanding Medicaid? — This report from the Urban Institute examines comprehensive state-level fiscal analysis to conclude that expansion helps state budgets, generating savings and revenues that exceed increased Medicaid costs.
- Medicaid Expansion in North Carolina: Health Insurance for Working Individuals and Families, a report from NC Justice Center, Families USA, and NCCHCA.
- How States Stand to Gain or Lose Federal Funds by Opting In or Out of the Medicaid Expansion, The Commonwealth Fund.
- Falling Through the Cracks: Medicaid Expansion and Opt-out States, The Geiger Gibson/RCHN Community Health Foundation Research Collaborative.