North Carolina reached significant milestones in health, with more people gaining insurance and some on track to have their medical debts forgiven. 

Gov. Roy Cooper announced this month that more than 600,000 people had enrolled in expanded Medicaid. The state has been enrolling people in expanded Medicaid for a little more than a year and the pace of sign-ups is twice as fast as expected. 

Cooper fought for Medicaid expansion for years. He started pushing for it even before he was sworn in as governor nearly eight years ago. 

Over the years of debate, Medicaid expansion advocates estimated that 600,000 people would be eligible for insurance coverage under expanded Medicaid. 

As the state reaches this milestone, challenges may lie ahead. 

The state law expanding Medicaid has a trigger that would dissolve it if the federal government stops paying 90% of the cost. Health policy experts worry, with Republicans controlling the White House and both chambers of Congress, the federal government may reduce cost sharing. 

Medical debt

Cooper and state Department of Health and Human Services Secretary Kody Kinsley enacted a plan allowing hospitals to collect increased federal payments in exchange for forgiving some patients’ old debts and helping them avoid new debt. 

All the state’s hospitals signed on. 

North Carolina has one of the highest percentages of adults who report having medical debt, according to the Peterson Center on Healthcare and KFF. 

Cooper and Kinsley said the plan has the potential to erase $4 billion in debt for 2 million people. 

Dental care

Despite this progress, the healthcare system is still failing to meet the needs of low-income residents and marginalized communities. 

A state report said that Medicaid doesn’t pay dentists enough to treat people who use it as their insurance. 

Medicaid reimbursement rates for dental care haven’t changed since 2008.

About 40% to 45% of active licensed dentists participate in the Medicaid dental program. Many are not accepting new patients, the report said.

In 2022, dental procedures comprised 14% of services to Medicaid beneficiaries. Around 2% of Medicaid payments went to dental providers.

Children and adults are living with untreated cavities. About 20% of kindergarteners untreated tooth decay, according to DHHS data.  

Dental care can be hard to find in rural counties. 

Ninety-four of the state’s 100 counties have shortages of dental health care professionals. Four eastern counties have no dentist, according to UNC’s Sheps Center for Health Services Research. 

Maternal mortality

The state’s maternal mortality review committee reported this year that 65 of the 76  pregnancy-related  deaths in 2018 and 2019 were preventable. 

The death rate for Black people was 1.6 times higher than for white people. 

Some of the committee’s recommendations for reducing maternal deaths centered on expanding the availability of doula services. Specifically, it recommended incorporating community health workers, doulas, and care managers into obstetrics care, and reimbursing doulas through Medicaid. Doulas offer support through pregnancy and labor. Some continue to work with families after babies are born. 

More than half the births in North Carolina are covered by Medicaid. 

An insurance company that operates Medicaid managed care plans published a report saying that pregnant women who use Medicaid and doula services are less likely to have cesarean sections and less likely to experience postpartum anxiety or depression. 

The report published by the public policy arm of Elevance Health added to the stack of research on the benefits of doulas. 

The legislature has not funded Cooper’s budget requests for doula reimbursements under Medicaid. 

Unequal access

The Commonwealth Fund reported that North Carolina is near the worst state for Latinos who need healthcare. The uninsured rates for Latino children and adults in North Carolina are higher than national rates. 

Despite the lack of access, healthcare outcomes for Latino residents are among the best in the country. 

Blue Cross Blue Shield, the state’s largest insurer, told the Association of Mexicans in North Carolina that even when Latino residents have insurance, they are less likely to receive healthcare. 

Blue Cross representatives came to the group looking for recommendations and insights. 

Latino residents insured by Blue Cross are less likely to have colorectal cancer screenings, to have their high blood pressure or diabetes under control, and less likely to receive timely prenatal care and postnatal care than people of other races and ethnicities who have Blue Cross insurance.