Navigating Changes to Medicaid: What North Carolinians Need to Know in 2023 - TribPapers

Navigating Changes to Medicaid: What North Carolinians Need to Know in 2023

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Hendersonville – What are the changes that recipients of Medicaid are looking at now in 2023?
Prior to the COVID-19 pandemic, every state regularly evaluated whether each of their Medicaid enrollees were still eligible for the program and dropped those no longer meeting their state’s eligibility criteria. This process, called redetermination, was suspended in March 2020 due to the pandemic-related public health emergency, but resumed in 2023. In North Carolina, redeterminations are managed by local Departments of Social Services (DSS).

North Carolinians who were covered by Medicaid during the pandemic but are no longer eligible, or who were unable to be reached by their DSS to verify that they are still eligible, began losing Medicaid coverage in July. While many of them may still be eligible for Medicaid, those who are no longer eligible will need to find alternative health insurance.

One option for these North Carolinians are Health Insurance Marketplace plans offered by health insurers in their county. Some of these plans are available with subsidies that result in low or even zero premiums. AmeriHealth Caritas Next’s Health Insurance Marketplace plans are available in Buncombe and 34 other North Carolina counties. Americans who lose Medicaid coverage due to the resumption of redeterminations may enroll in a Health Insurance Marketplace plan of their choosing between the day they lose coverage and July 31, 2024. Once consumers apply for Affordable Care Act marketplace coverage, they have a 60-day window to pick a plan.

Separately, Friday Health Plans, one of the Health Insurance Marketplace insurers in Buncombe County, will cease operations on August 31. Friday Health Plans members can switch to another plan between now and October 30 to assure coverage for the remainder of this year, although they would need to elect a new plan by August 31st to avoid a gap in coverage.

What brought about these changes?

Shortly after the COVID-19 pandemic began in early 2020, the federal government enacted a public health emergency which, among other things, required states to provide continuous Medicaid coverage for any existing enrollees and any newly added enrollees as long as the emergency remained in effect. At the end of last year, as part of legislation passed to fund the federal government, this continuous coverage provision was de-coupled from the public health emergency with the mandate that states resume the redetermination process no later than April 2023. Each state is taking its own approach to the timing and process for the resumption of redeterminations; some states began terminating enrollees’ Medicaid coverage before others.

North Carolinians who have had Medicaid coverage since the beginning of the pandemic or obtained coverage during the pandemic may lose benefits because they are no longer eligible, or because they were unable to be reached to verify that they are still eligible. We began seeing these disenrollments in July.

3-What can residents and recipients of Medicaid do to get on board with the changes and stay in front of what they might need moving forward?
North Carolina Medicaid enrollees are urged to make sure their local DSS has accurate, up-to-date contact information for them and their family members. It is also important to be on the lookout for any mail from their DSS to be sure they don’t miss any important information regarding Medicaid benefits. Those who cannot be reached may lose their Medicaid coverage.

It is also important to note that Medicaid enrollees have an annual redetermination (or recertification) month, so some people may not be notified for several months. The enrollee’s DSS begins its review process about 90 days before the termination date would occur.

Medicaid enrollees who need assistance with locating their DSS office can contact their Medicaid plan’s Member Services team.

Those no longer eligible for Medicaid and interested in enrolling in a Health Insurance Marketplace plan should visit to find the plan available in their county that’s right for them.

More information is also available on the NC DHHS website at:

Article provided by Monte Speicher, AmeriHealth Caritas Next.