Karen Garloch

Hundreds of thousands still fall into ‘Medicaid gap’ in North Carolina

March 08, 2016 06:59 PM

Last fall, Lue Raven, 55, got laid off from her job as a social worker at a long-term care center in Charlotte.

For the first time in her adult life, she found herself without health insurance. And when she tried to buy a private policy through the online marketplace, she was surprised to learn she didn’t qualify for a federal premium subsidy that would have made insurance affordable.

She falls into what’s called “the Medicaid gap.”

Her income is too low to qualify for a subsidy, and because she’s not disabled and doesn’t have small children, she doesn’t qualify for coverage under the state’s Medicaid program for low-income and disabled residents.

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“She’s really just the face of a much larger crisis in North Carolina,” said Madison Hardee, a lawyer with Legal Services of Southern Piedmont. “We have hundreds of thousands of people in her same situation.”

Health care experts will discuss “Closing the Coverage Gap in NC: Where We Go From Here” from 11:30 a.m. to 1 p.m. March 16 at Myers Park Baptist Church, Heaton Hall, 1900 Queens Road. The program is free, but the charge is $10 for lunch. Register at www.goleaguego.org/Lunch.html.

Speakers will be Adam Linker, co-director of the Health Access Coalition at the N.C. Justice Center; Susan Shumaker, president of Cone Health Foundation; and Rob Luisanna, managing partner of Pilot Benefits, a Greensboro insurance agency.

Gov. Pat McCrory and the Republican-led legislature have blocked Medicaid expansion that would have added health insurance coverage for an estimated 300,000 to 500,000 North Carolinians.

The Medicaid gap was created when North Carolina’s lawmakers refused to accept the ACA’s option to expand the federally funded health care program.

North Carolina is one of 19 remaining states – also including South Carolina – that have not expanded Medicaid as the ACA intended. In those states, people who fall below the federal poverty line get nothing while those who earn just above $11,700 can get hundreds of dollars a month in federal aid.

Under the ACA, the federal government covers 100 percent of the cost of Medicaid expansion through the end of this year. After that, the percentage decreases to 90 percent by 2020 and beyond.

Gov. Pat McCrory and the Republican-led legislature have blocked Medicaid expansion that would have added coverage for an estimated 300,000 to 500,000 North Carolinians.

A recent poll, commissioned by N.C. Child, shows there is bipartisan support for accepting Medicaid expansion. Overall, 72 percent of North Carolina voters support closing the gap, including 62 percent of Republicans, 84 percent of Democrats, and 62 percent of Independents.

The poll was conducted by Public Policy Polling, which surveyed 2,003 North Carolina voters in automated phone interviews in January.

Raven, the social worker who lost her job and her insurance, said she had to go to the emergency room – one of the most expensive venues – to get some of the medicines she takes for high blood pressure and chronic leg pain.

When her supply of pills got low, she said she called several Charlotte clinics that serve low-income patients, but none were accepting new patients. After explaining that she has high blood pressure, she said the receptionist at one office told her, “The best way for you to get your medication is to go to the emergency room,” where patients can’t be turned away.

Since then, Raven has visited a free clinic, Charlotte Community Health Clinic. But she’d prefer to have insurance and see her own private doctor.

“I can’t understand it,” she said. “I’ve worked all my life. Why can’t I get health insurance?…I’m not married. I have nobody to depend on. It’s just me. I’m leaning on the system right now to help me.”