#002: NC Medicaid Expansion: It's Finally Happening!

North Carolina announced that on December 1st of 2023, Medicaid Expansion would become a reality for more than 600,000 North Carolinians with access to healthcare services. In celebration with Abby Emanuelson, former Executive Director of Care4Carolina, a coalition of nearly 200 organizations working toward Medicaid Expansion in North Carolina. She shares insights on the coalition’s role in the legislative process, implementation, and enrollment efforts. 

Care 4 Carolina Materials: https://www.ncallianceforhealth.org/projects/

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Transcript

00;00;00;00 - 00;00;14;25
Abby Emanuelson
Once legislative leaders publicly announced their support. And this started beginning late last year, we remained cautiously optimistic that expansion would come to North Carolina. We just weren't sure when.

00;00;14;27 - 00;00;38;22
Liz Church
Welcome to the Atrómitos Way Podcast, where we have meaningful discussions on the challenges in healthcare and the solutions behind them. I am your host, Liz Church. Each episode, we dive into the complexities of our health and social system, gaining the experiences and insights of the guests that shape our lives and our communities.  It's happening. It's finally happening. At the time of this recording in October of 2023, we have a celebration on our hands.

00;00;38;22 - 00;01;03;09
Liz Church
Ladies and gentlemen, North Carolina has announced that on December 1st of 2023, Medicaid expansion will become a reality for more than 600,000 North Carolinians with access to health care services. We are celebrating today with Abbe Emmanuel Sen, the Executive Director of Care for Carolina, a coalition of nearly 200 organizations across the state striving for it to have the promises of Medicaid expansion realized for all residents.

00;01;03;11 - 00;01;26;10
Liz Church
She's here today to describe care for Carolina's role in legislative process implementation, and then their future role with enrollment. Without further ado, let's begin. Abby. Hello and welcome, my dear. So obviously, Medicaid expansion is the primary focus for care for Carolina. Can you walk us through what the organization's involvement has been during the legislative process to advocate for this expansion?

00;01;26;13 - 00;02;08;14
Abby Emanuelson
Thank you so much for having me. Medicaid expansion has and is for Carolina's only focus. It's why organizations came together eight years ago to have a voice at the North Carolina General Assembly that would solely focus on closing the health insurance coverage gap. With strong opposition by Republican legislative leaders, we went about building community support of local leaders, county by county to share the number of people in the health insurance coverage gap, working the cost of the marketplace plans in rural communities, and how much economic activity would come to the county if we expanded as a state.

00;02;08;16 - 00;02;43;24
Abby Emanuelson
And once we started gaining local support, we started sharing those data points with their constituents, support with members and their constituents, support with members of the legislature, Medicaid expansion, house and Senate champions emerged and kept taking this issue to their leadership. And then once the American Rescue Plan set aside funding for non expansion states, Medicaid expansion advocates like care for Carolina added had additional leverage to push for expansion.

00;02;43;26 - 00;02;58;20
Abby Emanuelson
And so once legislative leaders publicly announced their support and this started beginning late last year, we remained cautiously optimistic that expansion would come to North Carolina with just one share win.

00;02;58;22 - 00;03;17;26
Liz Church
And it's taken a really long time for this to get into effect, right? It's been one of those things where like, okay, we're going to wait and it's going to happen. And then a delay comes and then there's another delay. Oh look, there's another delay. And it was ten years of, you know, I think going in circles, if we can be blunt.

00;03;17;29 - 00;03;27;06
Liz Church
So now that it's been approved in North Carolina, what impact do you expect the expansion to have for those who will now have coverage?

00;03;27;08 - 00;03;50;25
Abby Emanuelson
I am so thrilled that we have this and are moving forward with it. More Medicaid expansion. You're exactly right. It's been a long time coming. And in fact, it became law in March of 2023. But however, there was a trigger clause that the state budget had to pass or and have to be enacted, either with the governor signing it or becoming law without a signature governor.

00;03;50;25 - 00;04;13;25
Abby Emanuelson
When the budget passed at the end of September, Governor Cooper chose for the budget to become law without his signature, and directed North Carolina Department of Health and Human Services to work with the centers of Medicare and Medicaid Services to get authority to go to set up the live date. And we're excited that that go live date now is December 1st.

00;04;13;27 - 00;04;46;08
Abby Emanuelson
So we think that with so many North Carolinians that have had Medicaid during the public health emergency, we know that about 300,000 are now eligible for North Carolina's expanded Medicaid state. And advocates have been urging these individuals to stay enrolled, even if it's for a temporary benefit, as is, just to make sure that they stay registered in the system, and they and all of their information is updated so that they can be the first ones to be enrolled in expanded Medicaid.

00;04;46;09 - 00;05;19;06
Abby Emanuelson
First and foremost, for those that have had Medicaid, this hopefully means that they will continue with their medical providers for primary care and then for the new enrollees that will seek care from a primary care physician or provider and rather than an emergency room. And we've learned from other expansion states that so many improvements in health outcomes will come because of Medicaid expansion, cancer survival, better management of heart disease and diabetes, staving off diabetic amputations, and costly stroke rehab.

00;05;19;07 - 00;05;25;00
Abby Emanuelson
There's so many good health outcomes that are going to happen for so many Americans that live in North Carolina.

00;05;25;02 - 00;05;44;17
Liz Church
Because of all these delays, I, I, I am not wholly familiar with when things start and being implemented. I just know December 1st is the day, but how long do you think the process will be? Where people will have, you know, whether they are enrolled or the content of their enrollment? How long does it typically take for people that are coming aboard?

00;05;44;19 - 00;05;51;06
Liz Church
How long do you foresee the state being able to get where people have their coverage? Day one.

00;05;51;09 - 00;06;16;04
Abby Emanuelson
So, for those that are on the family planning plan right now in North Carolina, we they the state is estimating about 300,000 will have coverage on the first day. There will be some individuals that start applying on the first day, or they could apply now. But we really think that they have an opportunity to really go ahead and get applied.

00;06;16;12 - 00;06;36;18
Abby Emanuelson
And then we've heard that it takes up to 45 days to get to get cover it, to get coverage, but we are also learning that they can be it's retro to the date that you apply. So it's a really aggressive plan that the state has for outreach. And we hoped and care for Caroline to be a big partner in that group.

00;06;36;20 - 00;06;55;01
Liz Church
That's amazing. You all are able to help and provide that information and you know everybody that can be that's eligible. They should be enrolled. They know what to do and how to do it. And this is really great. So the next question I have for you, Medicaid expansion, obviously has the potential to benefit hundreds of thousands of people in North Carolina.

00;06;55;01 - 00;07;09;15
Liz Church
So how does care for Carolina plan to ensure that eligible people are eligible? People sorry about that. Do know about the expansion and how to enroll all of the things we just said. How is Caregiver Carolina going to facilitate that part?

00;07;09;18 - 00;07;40;17
Abby Emanuelson
Well, I mean, I'm really excited about this role. With that, we're going to be able to play in in the enrollment process. We have just had so many active stakeholder groups committed to the success of Medicaid expansion. We've been to so many North Carolinians, the foundations, the philanthropic groups, our stakeholders have just really kept this moving and have allowed us to have some funding to keep us through going through next year so we can be actively involved in the enrollment process.

00;07;40;18 - 00;08;15;13
Abby Emanuelson
We have already committed to our funders and our stakeholders and even to the North Carolina Department of Health and Human Services, to play a support role in implementation efforts. We're going to, as care for Carolina, be a part of the public awareness campaign, ensuring that trusted community voices are encouraged to get involved into the coverage and get people covered will be leveraging our media expertise to share the stories of farmers and fishermen and firefighters, as well as the construction worker and child care provider and nursing assistants.

00;08;15;13 - 00;08;39;11
Abby Emanuelson
Getting enrolled and getting the health care that they have been waiting for. And then we've also partnered with the North Carolina Community Health Workers Association and other community based organizations to support outreach and enrollment events in our communities. We hope that some deep dives in the communities will help get people more engaged and and aware of that this is coming to them.

00;08;39;17 - 00;09;03;21
Abby Emanuelson
And as I mentioned before, all, there's so many individuals that think they that they may have qualify for benefits in December are encouraged to register with E pass. And that's the it's e pass that NC gov. And if you can set up an account there now you may qualify for benefits and then once expansion begins you may be ready to start your own enrollment process.

00;09;03;21 - 00;09;30;23
Abby Emanuelson
And and then again, if you prefer to talk to someone this is a little bit overwhelming. You can visit your county social services department, or reach out to a navigator and a community based organization like Community Health Clinic. That's a good place to, to get information. And we believe that and have heard that there's a lot of information coming out from the North Carolina Department of Health and Human Services as early as today about getting new information out there.

00;09;30;27 - 00;09;55;14
Abby Emanuelson
Further down the process, we hope that North Carolina will be determination state. And that means that once people in addition to E-pass, they can go on to health care gov and learn whether or not they're eligible for Medicaid expansion. And so this should start later in the enrollment process. But it'll be a good key way for people to easily or more easily get enrolled in Medicaid.

00;09;55;16 - 00;10;01;17
Liz Church
Looking forward, what do you envision Cara for Carolina's role being during the enrollment phase of Medicaid expansion?

00;10;01;20 - 00;10;36;16
Abby Emanuelson
Well, we have estimates of the number of individuals in each county that are eligible for expanded Medicaid. So with the resources that I previously shared a statewide network, media campaigns, community health workers, community based organizations, we hope to have the flexibility to target communities that should have higher rates but are not getting them. And so with media, we really want to engage in those efforts to to target them and just to make sure that they have the resources to get the word out.

00;10;36;23 - 00;11;03;12
Abby Emanuelson
One of the things that we are also watching for is the metrics to start to begin. In addition to the enrollment metrics, but there's also pieces of health outcomes that we hope to amplify with successes, with the experiences of North Carolinians that have gained health care and are now getting treated for, as I mentioned, diabetes or high blood pressure and getting the mental health or substance use treatments that they have been delayed.

00;11;03;12 - 00;11;32;08
Abby Emanuelson
So we're going to that's going to be tracked. Those were those are resources that were really beneficial in us telling the story from former oxidation states. So we hope that we can use those as well to help share the success of North Carolina. And then with C4 C's focus on business and economic development, we really also want to talk about North Carolina and having a healthier workforce, a previously.

00;11;32;11 - 00;11;52;16
Abby Emanuelson
And that could be like a previously uninsured restaurant worker that now is only out for a shift or two because they have got an antibiotic or that home health aide that's been like caring for that veteran, has gotten treatment for her chronic illness and stabilized so that now that they can work five days a week instead of three.

00;11;52;19 - 00;12;03;15
Abby Emanuelson
These are a key things that we also want to share and share the stories of, and the metrics for, to get expansion more popular so that people really know it's helping North Carolinians.

00;12;03;17 - 00;12;26;13
Liz Church
And sharing personal stories. I generally image storytelling is the way to drive people for meaningful change, for people to understand where there's benefits and downfalls, the things in our system, and when something great happens and how it benefits people. Sharing these stories is really impactful and I love storytelling. I love being able to share people's stories, especially here, because you can actually connect with them and you can bring people in.

00;12;26;13 - 00;12;36;23
Liz Church
There's personalization in there, and I think it's very impactful. Are you guys going to be doing anything? It's going to be like a video series or stories or social media posts, anything along that low?

00;12;36;24 - 00;13;04;04
Abby Emanuelson
I think it might be a combination as we kind of get deeper into it, we'll decide what we have the resources to to do. You know, everybody has such a great story to share. I find people like you so interesting and and just in that curiosity is really what drives me deeper into the community so that we can get more people to the the connections that help get them to the treatment that they need.

00;13;04;07 - 00;13;16;09
Liz Church
Doing the good human thing. So with that, how can people like me, little individuals and communities, get involved or support care for Carolina's mission to expand health care access in North Carolina?

00;13;16;11 - 00;13;40;25
Abby Emanuelson
Well, thank you for that question. It's, we would just love for more people and organizations involved to be involved in our stakeholder network during the expansion debate. We focus more on rural conservative areas, but Medicaid expansion is going to help everyone in the state. And so our network needs to reflect that. So we are digging deeper into urban areas as well.

00;13;40;25 - 00;14;20;16
Abby Emanuelson
But and then there's a couple rural areas we missed too. So we're heavily reaching out in those communities. So whether you're a business or a nonprofit leader, medical provider and or, you know, or an industry that's really been working on other social determinants of health, whether it's the housing or food issues, we will we welcome you, and we would love for you to share what you are doing and leveraging in your community network so that we have that we've already identified, but we just think that it's just key that we all increase our knowledge of this so that it can be helpful and care for Carolina folks to play a role in that awareness building.

00;14;20;21 - 00;14;46;03
Abby Emanuelson
And the there's lots of ways to join. You can email me, you can visit our care for Carolina. And that's the number for not for, but the so the actual enumeration of it care for carolina.com and act now or can email me as I mentioned and we have a lot of information that we're working with and and leveraging among our partners and the Department of Health and Human Services.

00;14;46;03 - 00;14;56;24
Abby Emanuelson
So I really do think that if you want a presentation or want some materials, we can help you get them. So just let us know what you need and we'd love to hear from you.

00;14;56;26 - 00;15;19;09
Liz Church
That's great stuff. I'll include it in the episode Show Notes for everybody. So, Abby, as we close out today's conversation, I want to give you the opportunity to have a call to action. So that's my final question for you in the grand scope of the health care industry and the challenges that it faces, what's one piece of advice or a call to action you would like to leave the listeners with?

00;15;19;11 - 00;15;28;03
Liz Church
How can each of us, regardless of our role or background, contribute to meaningful change in health care without being deterred by the obstacles ahead?

00;15;28;06 - 00;16;02;07
Abby Emanuelson
Well, this may not answer your question directly, but certainly what came to mind as thinking about obstacles is that North Carolina is the 40th state to expand, and there are ten more holdout states. And those state leaders are saying some of the same things that ours did. On why they haven't expanded yet. It took people being brave and vulnerable to share their story of themselves or their parent, or an adult child facing health struggles that by chance or I haven't experienced or faced yet.

00;16;02;09 - 00;16;42;22
Abby Emanuelson
But it also took political leaders listening to these individuals making their expansion happen so so that we could have expansion here. And so instead of being an obstacle, I hope that the way North Carolina got to Medicaid expansion, how we implement the program and how we begin enrollment on December 1st is really gives those states there's not expansion states and and health to advocates, because we cannot have done this without health advocates across the state, in the country actually have the fortitude to get into those communities and overcome the obstacles that are currently ahead of them.

00;16;42;22 - 00;16;54;03
Abby Emanuelson
So I hope that we really are a bright light for some. So many states that really know that Medicaid expansion is going to benefit them if they can just get it implemented in their states.

00;16;54;05 - 00;17;10;00
Liz Church
You know, what is it? There's ten states left in the entire country that hasn't expanded Medicaid yet. You know, maybe North Carolina could be a shining example that yes, it can happen. And I'm glad that we have a date. We now have a date that it's going to happen. You know, we were wondering, is it going to be September 1st?

00;17;10;00 - 00;17;11;11
Liz Church
And then it got pushed to October.

00;17;11;11 - 00;17;37;20
Abby Emanuelson
And it was, yes, October 1st. And it was all dependent upon when the budget it was, passed. So the but the state has been working towards this, DHHS has been working towards this for such a long time in advance that, you know, will be one of the fastest turnaround states and probably and I'm and I'm confident, one of the best states that were able to put this together because so many great people have been involved.

00;17;37;26 - 00;17;46;06
Abby Emanuelson
We've had a lot of great support, really, and Michelle was one of those folks that were really helping us kind of like, okay, let's get it together.

00;17;46;06 - 00;18;08;06
Liz Church
Yeah, she does that for everyone. that she just does. But I am really looking forward to what happens next, the next chapter of everything that ten years that you guys have spent working together to make sure that Medicaid expansion came to North Carolina is a real deal. It's the real thing. So yeah, this is fantastic. I, I just love every moment of it.

00;18;08;06 - 00;18;13;25
Liz Church
And Abby, thank you so much for coming aboard today and speaking with me. We're looking forward to the future.

00;18;13;27 - 00;18;16;29
Abby Emanuelson
Well, I am too. Thank you so much.

00;18;17;02 - 00;18;41;25
Liz Church
This is an important time to celebrate this long sought milestone with all stakeholders, and hope that one day Medicaid expansion will become a reality nationwide. I do have a little editorial note for you all, and I made this update when the update became available. So in February of 2024, Kara Carolina announced that they were going to sunset the organization in spring of 2024.

00;18;41;27 - 00;19;02;17
Liz Church
I had mentioned in the episode itself that I was going to be looking at items spoken in our resources center, you know, in the episode Show notes, but I wanted to highlight here that's changed all of care for Carolina's archives and coalition materials will be housed with the North Carolina Alliance for health, which I have linked in the episode Show Notes.

00;19;02;20 - 00;19;24;08
Liz Church
And I want to quote Abbie here as a closer. This is from the public statement that was made when the announcement came out. Care for Carolina was formed to do one thing. Find a solution to close the health insurance coverage gap in North Carolina. We long believed, while difficult, closing that gap through the expansion of Medicaid was achievable.

00;19;24;11 - 00;19;41;18
Liz Church
Our partners in this effort helped us form one of the most unlikely bipartisan cross industry coalitions ever assembled in North Carolina, and we succeeded. Yes, you did. Yes you did.

00;19;41;20 - 00;20;40;08
Liz Church
The Atrómitos Way is produced by me, Liz Church. Editorial assistance for this episode was by my fantastic team at Atrómitos. I would like to express our heartfelt appreciation to our guests who shared their expertise, stories, and insights with us on the podcast—finally, a big thank you to our listeners. Your support and engagement have meant the world to us at Atrómitos.  

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