Medicaid Unwinding in North Carolina: What You Need to Know If You Lose Coverage
Key takeaways:
Medicaid renewals in North Carolina are changing because of the end of the COVID-19 public health emergency (PHE) on May 11, 2023. This is being called the unwinding of Medicaid, and some people will lose coverage during this process.
During the PHE, Medicaid renewals were automatic, and enrollees had continuous coverage. As part of the unwinding process, automatic renewals for Medicaid and the Children’s Health Insurance Program (CHIP) stopped nationwide on March 31, 2023.
North Carolina Medicaid has started reviews to see who is eligible to continue receiving coverage. Make sure they have your current contact information. If they can’t reach you, or if you’re no longer eligible for Medicaid or CHIP, you could lose coverage as early as July 1, 2023.
The U.S. Department of Health and Human Services declared a public health emergency (PHE) for COVID-19 in January 2020. The PHE was renewed a dozen times between January 2020 and February 2023.
People who qualified for Medicaid during the COVID PHE were able to keep their coverage throughout the pandemic without having their eligibility reviewed. This is because all states, including North Carolina, were required to provide continuous coverage during the PHE.
But the PHE ended on May 11, 2023, and automatic Medicaid renewals stopped on March 31, 2023. As a result, 8 million to 24 million enrollees nationwide could lose Medicaid coverage over the next year as eligibility reviews begin again.
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The North Carolina Department of Health and Human Services (NCDHHS) oversees and administers NC Medicaid, the state’s Medicaid and Children’s Health Insurance Program (CHIP). It’s important to note that children formerly enrolled in NC Health Choice were moved to CHIP on April 1, 2023.
Local Department of Social Services (DSS) offices will conduct NC Medicaid eligibility reviews for 2.9 million enrollees. This is called the redetermination process.
NC Medicaid estimates that 300,000 people in the state could lose Medicaid as renewals resume. People who no longer qualify could be disenrolled as early as July 1, 2023 — and some lost coverage as early as May 1, 2023.
Here’s what you need to know about Medicaid changes in North Carolina and what to do if you lose Medicaid coverage.
Why is Medicaid changing nationwide?
After the PHE ends, COVID-19 will remain a public health priority — just not an emergency. As part of this process, Medicaid renewals will no longer be automatic. This is being referred to as the unwinding of Medicaid.
The unwinding will affect Medicaid in every state, Washington, D.C., and five U.S. territories.
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What’s happening with Medicaid renewal in North Carolina?
NC Medicaid has plans to review about 200,000 cases per month over a year to determine eligibility for more than 2 million enrollees.
It’s important for you to confirm or update your household’s contact information with NC Medicaid by either:
Logging in to your account on the ePASS self-service portal account
Visiting your local DSS office
The state is also warning Medicaid enrollees about renewal scams. Any letter requesting information should come from your local DSS. If not, the letter could be a scam. If you receive something, but you’re not sure it’s an official request, contact your local DSS office.
What to expect during the renewal process
NC Medicaid already has enough eligibility information from other programs to renew some cases automatically. If more information is needed, you will receive a renewal letter.
If you receive a letter, you can submit your renewal in these ways:
Log in to your ePASS self-service portal account if you have an enhanced ePASS account
Mail the form to your local DSS office
Call your local DSS office
Visit your local DSS office
Fax the form to your local DSS office
Email your local DSS office — if they accept email
Once your completed renewal is reviewed, you will receive one of these decisions:
Notice that your benefits will continue: This means you are still eligible for NC Medicaid. Check and make sure the information on your letter is correct. If not, follow the instructions on the letter to make changes.
Notice about your coverage changing: You are still eligible for Medicaid, but you qualify for a different type of coverage. Your letter will explain the type of coverage you have now and if you need to take further action.
Notice that more information is needed: Your letter will indicate that more information is required to finish your redetermination. You will have 30 days to return this form.
Notice that your coverage is terminated: You are no longer eligible for NC Medicaid. The letter will also explain the next steps to help you access alternative health insurance such as the Affordable Care Act marketplace. You can also appeal the decision or reapply.
If you need to reach NC Medicaid by phone, call the NC Medicaid Contact Center at 888-245-0179.
Tribal health and Medicaid unwinding
The National Indian Health Board estimates that as many as 236,000 American Indians and Alaska Natives (AIs/ANs) could lose Medicaid coverage during the unwinding process.
State liaisons are reaching out to people who are enrolled in Medicaid and who are also members of or affiliated with Native American tribes. NC Medicaid has a managed care option for state residents who are members of federally recognized tribes.
What should I do if I lose my Medicaid coverage in North Carolina?
In order to receive Medicaid in North Carolina, you must meet all of the following criteria:
You must be a North Carolina resident.
You must be a U.S. citizen, permanent resident, or legal resident.
You must need assistance with access to healthcare or insurance coverage.
Your annual household income before taxes are withheld must be below the limit for your household size.
In North Carolina, you may also qualify for reasons other than income, including if you are:
Pregnant
A child or teenager
Responsible for the care of a child who is 18 years old or younger
Blind
65 years old or older (and meet certain criteria)
A person with a disability, or you have a person in your household who has a qualifying disability
A former foster child
In need of nursing home care
Age 19 and older with family planning needs
In need of treatment for breast or cervical cancer (and have been screened or are still undergoing treatment)
If you no longer qualify or NC Medicaid can’t reach you, you will no longer be able to use your benefits, which could leave you temporarily uninsured.
If you lose your coverage but believe you still qualify, you can appeal the decision or reapply for Medicaid. You may be uninsured for a while until you’re approved for coverage again.
If you choose not to reapply for Medicaid coverage, or if you’re no longer eligible, you may qualify for other low-cost or free healthcare options. You can also use GoodRx coupons to save on your prescription medications. In addition, you may be able to enroll in an alternative health insurance plan such as:
Affordable Care Act (ACA) marketplace plan: You may be able to find an ACA health plan for $10 or less per month if you qualify for a premium subsidy. If you lose Medicaid, you can purchase a plan in the ACA marketplace during the unwinding special enrollment period from March 31, 2023 to July 31, 2024.
Employer plan: Your company may offer employer-sponsored health insurance.
Medicare: If you have a qualifying disability or condition — such as end-stage renal disease or ALS (amyotrophic lateral sclerosis), commonly referred to as Lou Gehrig’s disease — you can enroll in Medicare at any age.
Partner’s plan: If you have a spouse or domestic partner who has insurance, you may be able to join their plan during an open enrollment or special enrollment period.
Special plans: Short-term insurance can be a great choice if you anticipate that a better option, like job-based health insurance, will be available soon. You may also consider alternative and limited-benefit plans, such as fixed indemnity, accident, cost-sharing, and catastrophic insurance plans.
Student health plan: If you’re enrolled in a college or university, you may be eligible for a campus health plan.
U.S. Department of Veterans Affairs (VA) benefits: If you are an active-duty service member or a veteran, you may qualify for TRICARE coverage or VA benefits and services.
North Carolina Medicaid resources
Here are some resources where you can learn more about Medicaid in North Carolina and upcoming changes related to the end of the public health emergency:
North Carolina Medicaid office: The North Carolina Department of Health and Human Services oversees and administers the state’s Medicaid program, NC Medicaid.
North Carolina Medicaid self-service portal: You can visit the ePASS self-service portal and access your account online 24/7 to confirm or update your contact information.
North Carolina Medicaid redetermination: Read more about North Carolina’s plan to process more than 2 million Medicaid renewals and a fact sheet on how the redetermination process will work.
North Carolina Medicaid office phone assistance: You can call the NC Medicaid Contact Center at 888-245-0179.
The bottom line
Automatic Medicaid renewals stopped on March 31, 2023, in advance of the COVID-19 public health emergency’s conclusion on May 11, 2023.
NC Medicaid began resumed Medicaid renewals in April 2023 and will continue for a year. If you are no longer eligible for Medicaid or don’t respond to a renewal notice, you could lose coverage as early as July 1, 2023.
This is why it’s important for your contact information to be current with NC Medicaid. Take a moment now to confirm and update your mailing address, phone number, and other ways to reach you so that you can be contacted when it’s your turn to renew.
If you lose Medicaid, you may have other options including an Affordable Care Act (ACA) marketplace plan, job-based insurance, or Medicare.
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References
Centers for Medicare & Medicaid Services. (2023). Unwinding and returning to regular operations after COVID-19.
North Carolina Department of Health and Human Services. (2023). Children in the NC Health Choice program moving to NC Medicaid April 1.
North Carolina Department of Health and Human Services. (2023). NCDHHS to resume annual Medicaid recertification process.
North Carolina Medicaid. (n.d.). Fact sheet: Eastern Band of Cherokee Indians tribal option overview. North Carolina Department of Health and Human Services.
North Carolina Medicaid. (n.d.). Fact sheet: How NC Medicaid eligibility recertification works. North Carolina Department of Health and Human Services.
Tolbert, J., et al. (2023). 10 things to know about the unwinding of the Medicaid continuous enrollment provision. Kaiser Family Foundation.
Tribal Health Reform Resource Center. (2023). Medicaid unwinding. National Indian Health Board.
U.S. Administration for Strategic Response and Preparedness. (2020). Determination that a public health emergency exists.
U.S. Administration for Strategic Response and Preparedness. (2023). Renewal of determination that a public health emergency exists.
U.S. Department of Veterans Affairs. (2022). VA & TRICARE information.
