Medicaid expansion is providing a lifeline to rural North Carolina

North Carolina Health and Human Services Secretary Kody Kinsley, right, speaks while Gov. Roy Cooper listens at an Executive Mansion news conference in Raleigh, N.C., on Monday, Sept. 25, 2023. Kinsley and Cooper announced that North Carolina would launch Medicaid expansion coverage on Dec. 1. Expansion will be able to start because Cooper said he'll let a state budget bill sent by the General Assembly last week to his desk become law without his signature. (AP Photo/Gary D. Robertson)

By Dylan Rhoney

January 17, 2024

It’s only been a month and a half since Medicaid expansion launched in North Carolina, but it’s already been life changing for many residents.

The North Carolina Department of Health and Human Services automatically enrolled nearly 273,000 people into the program on Dec. 1, including more than 67,000 who live in rural areas, with a plurality of those being between the ages of 18-29.

Dr. Laura Ucik, a physician in Henderson, says that the program has been a boost for both doctors and patients. “It’s been truly phenomenal for the past month, finally being able to take care of people the way they deserve to be taken care of,” she said.

In addition to providing access to treatment, she says Medicaid’s structure is beneficial for patients.

“Medicaid is such comprehensive health insurance. It’s so straight forward, the co-pays are clear, the formula is clear. It’s just such a user-friendly health insurance. Patients are able to get dental care, they’re able to get transportation to specialty appointments that are in the city.”

Ucik says that many of her patients come from rural areas, and as a result of expansion, are now able to see a doctor and receive care for conditions that have, in many cases, gone untreated over a long period of time.

“Preventive care is the cornerstone of everything that I do,” she said.

In addition to preventive care, she says one of the key pillars of Medicaid expansion is that it allows patients to access better medication.

“Medicaid helps people access the top of the line, quality, recommended medications for their health conditions, like diabetes,” Ucik said. “That can help prevent them from having complications from that condition in the future.”


WATCH: Medicaid expansion was launched on Dec. 1st and it’s already having a big impact on North Carolina, the state’s top health official told us. Secretary of Health and Human Services Kody Kinsley told Cardinal & Pine that his office automatically enrolled 273,000 North Carolinians into comprehensive health coverage. Kinsley says the success of enrollment gives patients the ability to see a doctor and get needed medication. Those who may qualify can go to to see if they’re eligible to enroll. For our walkthrough of how to apply, click the 🔗 in our bio 🎥 Dylan Rhoney/Cardinal & Pine #ruralnc #hospitals #medicaidexpansion #northcarolina #ncpolitics

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North Carolina Secretary of Health and Human Services (NCDHHS) Kody Kinsley echoed this sentiment when discussing the access to medications the program provides. “Tens of thousands of people in just the first half of December were able to get prescription benefits filled.”

Kinsley said that the initial enrollments significantly benefited rural communities.

“Individuals in rural North Carolina are three to four times as likely to be uninsured as the general population. It’s no surprise that when we enrolled the first 273,000 people into Medicaid expansion, disproportionately those people were in rural North Carolina.”

Data released by the NCDHHS reveals that Robeson, Edgecombe, Richmond, Anson, and Scotland counties had the highest percentage of residents enrolled. All five counties are classified as rural by the NC Rural Center.

State Rep. Lindsey Prather represents some of the rural areas of Buncombe County, where more than 6,000 people have already been enrolled in coverage under the expansion. She believes that the program will provide support for local hospitals.

“We’re going to be able to divert people to places besides emergency departments, because that’s where people go when they don’t have insurance,” Prather said.

One of the burdens placed on hospitals has been the usage of the emergency room for non-serious issues. Previous studies have shown that if non-emergency situations were diverted from emergency rooms to places like urgent cares or non-emergency clinics, it could potentially save up to $4.4 billion annually.

Parker Chatham is the Executive Director of Restoration House, a low barrier homeless shelter in Bryson City, and the only one west of Asheville. He says that Medicaid expansion is having a positive impact on the people he works with on a daily basis, as well as the broader community in Swain County.

“Swain County has the lowest life expectancy rate in the state [70.6 years], and we have one of the lowest rates of insured populations [76.5% insured], and we have one of the highest rates of people below 200% of the federal poverty level.”

Chatham works with some of the area’s most impoverished residents, and believes Medicaid expansion is providing them a lifeline.

“Everyone who comes in my door qualifies for Medicaid. Even today I had someone come in who went across the street and got Medicaid,” he said.


Getting People Signed Up

By late December, around 280,000 total people had signed up for Medicaid, and it’s estimated that roughly 600,000 people in the state qualify for enrollment under the expansion.

In addition to NCDHHS, several organizations in the state are working to get rural residents enrolled, including Down Home North Carolina. Kate Daley, the group’s Health Justice Coordinator, says they will be working in counties across the state to raise awareness about the program, and to help get those eligible signed up.

“Down Home is in a really unique position to get the message out. We’re doing a lot of education and outreach to help identify, and find about 300,000 people in North Carolina who are eligible for Medicaid expansion but not yet enrolled,” Daley said.

The organization is holding a series of town halls where people can learn how to both sign up for Medicaid and become a volunteer for the organization’s effort to boost enrollment. Town halls are currently scheduled in Henderson, Boone, and Greenville. The event in Henderson will take place on January 18th from 6-8 p.m. (You can learn more here). The event in Boone will take place on Saturday March 2nd from 1-3 p.m. (You can find more information here).

In Swain County, Chatham said he has been helping people directly sign up in the past month. “I’ve helped at least ten people sign up for Medicaid since expansion happened.”


What Comes Next

Advocates for Medicaid expansion spent over a decade fightingadvocating for it in North Carolina. Now it’s a reality, providing much needed health coverage for hundreds of thousands of people in the state, with more people signing up every day.

But Medicaid expansion does not solve all the healthcare problems facing rural North Carolinians, many of whom face additional barriers to actually accessing care.

“Rural communities, especially here in North Carolina, we have no public transit. There’s no bus, there’s no train, there’s just no way to get around if you don’t own a car,” Dr. Ucik said.

Under federal regulations, Medicaid is required to provide enrollees access to transportation in non-emergency situations. Some Medicaid plans, like Healthy Blue through Blue Cross and Blue Shield, offer several methods of transportation support, including payment for public transportation to and from the appointment, reimbursement for mileage to and from an appointment, and provision of a taxi to get to and from an appointment. (You can learn more about Medicaid transportation options in your county here).

Other North Carolinians, meanwhile, remain without insurance.

Yeisel Dominguez lives in Moore County and had hoped that she and her husband would qualify for Medicaid once the expansion was implemented. However, when it came time to enroll, they realized they just missed the income requirement.

“My husband literally makes $100 more than what is allowed. Neither of us have insurance and his job doesn’t have insurance,” she said.

While Dominguez and her husband did not qualify for Medicaid, they have been able to seek medical care at the Moore Free and Charitable Clinic in Southern Pines.

Rep. Prather believes situations like this highlight the need for universal healthcare in the United States. “Ultimately we need a public option. We need universal healthcare,” she said.

While any debate over a universal healthcare system would need to take place at the federal level, Prather says that there are actions the state can take to maximize healthcare coverage.

“At the state level there are multiple things we can do without reinventing the wheel… we have a lot of nonprofits, community based organizations across the state that are doing good work to help people access these things. Give them more money,” Prather said. “We have organizations that are working, that have amazing people, that are connected to the communities they need to be connected with, that have already put the groundwork into getting people access to healthcare. We can do a better job at the state level to provide more funding to counties to disburse that to nonprofits.”


  • Dylan Rhoney

    Dylan Rhoney is an App State grad from Morganton who is passionate about travel, politics, history, and all things North Carolina. He lives in Raleigh.

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