PoliticsHealth Care


North Carolina Medicaid expansion an example for holdout states

Officials say the state's expansion will cover an estimated 600,000 people who fall into a "coverage gap."
Posted at 1:16 PM, Apr 11, 2023

In a rare bipartisan move last month, North Carolina lawmakers expanded the state's Medicaid program, giving health care access to 600,000 residents. Advocates say the move could serve as a road map for other states that have failed to expand the program. 

"When the parties come together and work on sound policy that improves people's lives, it's a great thing," said Rebecca Cerese with the nonprofit North Carolina Justice Center

North Carolina had been among 11 states that hadn't expanded the program, which largely helps give health insurance to the working poor. Ten states have yet to adopt Medicaid expansion (Wyoming, Kansas, Texas, Wisconsin, Tennessee, Mississippi, Alabama, Georgia, South Carolina and Florida), leaving nearly 2.1 million Americans in a coverage gap

All 10 states have Republican-controlled state legislatures that have mostly pushed back against Medicaid expansion, citing cost and fears that such support would discourage people from working. But in North Carolina, a Republican-led legislature worked with a Democratic governor to find a consensus to pass the bill.

"I think North Carolina is a perfect example of if it can get done here, it can get done anywhere," said Wesley Harris, a Democrat who represents the Charlotte area.

A physical therapist works with a patient.

Millions at risk of losing Medicaid benefits

An analysis from the Kaiser Family Foundation says up to 14 million Americans could lose Medicaid coverage when the automatic enrollment process ends.


Harris knows that Medicaid expansion for those 10 other states is an uphill battle, but seeing what happened in his state, he believes expansion is still possible.

"There's no excuse not to get it done," Harris added. 

"We need coverage in North Carolina for the working poor," said Phil Berger, Republican State Senate leader at the time of the bill passage. 

Kody Kinsley serves as the Secretary of Health and Human Services. He has spent years trying to help build bipartisan consensus on Medicaid.

"It was a joyous occasion" when the expansion was signed into law, Kinsley said, "but my mind goes to the countless advocates and North Carolinians who started on the journey who did not finish the journey," he added. 

Kinsley believes what ultimately got the legislation over the finish line was money. Because of a provision in the American Rescue Plan, North Carolina will get an additional $1.8 billion from Washington for expanding Medicaid. Kinsley says that's a big reason why lawmakers who once opposed expansion are now convinced that the working poor will benefit.