On Wednesday, July 26, the North Carolina Department of Health and Human Services (NCDHHS) announced an anticipated start date of Sunday, Oct. 1 for Medicaid expansion in the state – despite the fact that current budget negotiations in the NC General Assembly are keeping the actual start date up in the air.

The July 26 announcement by NCDHHS is part of a compromise agreement the department reached with the Centers for Medicare & Medicaid Services that allows NCDHHS to move forward with the required public notices for beneficiaries, counties and providers – while still waiting on final authority from the NC General Assembly.

In the meantime, Guilford County government is also hustling to prepare to provide the service, which will essentially constitute a new county division within the Guilford County Department of Health and Human Services.

In Guilford County, Medicaid expansion is expected to mean 33,000 more clients on the Medicaid roles – increasing the total to about 200,000 county residents, or 37 percent of the county’s population.

Guilford County’s new 2023-2024 fiscal budget takes this into account. It adds over 50 social services positions to help handle the new responsibility.  Though the total cost of expanding Medicaid in the county could mean a $5 million increase in the first year, just over $1 million is expected to be from county funds since the State of North Carolina is absorbing a lot of financial punch.

To launch expansion on October 1 at the state level, NCDHHS will still need official action to be taken by the NC General Assembly by the end of August— either by “de-coupling” Medicaid expansion from the budget, or through an enacted state budget that addresses the matter.

The work the department is doing now will reduce the original implementation period, from 90 to120 days after receiving legislative authority, to 30 days – so enrollment will begin sooner.

In the press release announcing the coming actions, NCDHHS Secretary Kody Kinsley reiterated the benefits of Medicaid expansion.

“We are thankful for leadership and partnership in passing Medicaid Expansion which will save lives, increase access to care and bring billions of dollars to North Carolina,” Kinsley stated. “Moving forward now sets the department on a path to be able to get health care coverage to thousands of people as soon as possible.”

The state’s implementation plan was originally created around obtaining final authority from the General Assembly by the end of June 30. However, ongoing budget negotiations have muddied the waters..

According to the July 26 release, “If NCDHHS does not have authority to move forward by Sept. 1, the earliest fallback date is Dec. 1, 2023, and depending on how late authority is given, it could fall into 2024. As part of the compromise to move forward, NCDHHS is opening the public comment period on the State Plan Amendment for Medicaid Expansion’s Alternative Benefit Plan, a legal document required to be submitted to the federal government.”

If you would like to submit a public comment, you can do so by visiting https://medicaid.ncdhhs.gov/medex-state-plan-amendment-new-medicaid-expansion-20230726/download?attachment.”