Standing on the second floor of the mostly empty North Carolina legislative building last week, Anthony Brooks sifted through a stack of papers until his finger landed on a troubling piece of mail he recently received from the state.
“This is my death certificate,” he said of the document, a letter informing the Beaufort County resident that he will soon be kicked off Medicaid.
Brooks’ monthly disability check — his main source of money after a 2022 heart attack that forced him to quit his job as a nursing assistant — is $7 over the state’s current income limit for the government-funded program.
Brooks, who is in urgent need of a surgically implanted defibrillator that he can’t afford without health insurance, would continue to qualify for coverage under Medicaid expansion, which was signed into law this past March by Gov. Roy Cooper. But expansion will not officially take effect until a state budget is enacted, leaving Brooks and hundreds of thousands of other expansion-eligible North Carolinians in limbo as lawmakers debate issues like casino legalization.
It didn’t have to be this way.
In late July, the N.C. Department of Health and Human Services announced a proposed workaround that would have “decoupled” expansion from the budget. The department needed only the General Assembly’s blessing to proceed. At that time, legislative leaders gave a nod to the plan, raising hope among advocates that expansion could move forward.
But for reasons that remain unclear, the proposal was ultimately rejected by Republican lawmakers. Kody Kinsley, head of DHHS, now estimates that expansion will not be implemented until December at the earliest — three months later than originally anticipated.
‘We get blown off’
On Thursday, Brooks traveled to Raleigh in hopes of sharing his predicament with the state’s top Republican legislators: House Speaker Tim Moore and Senate leader Phil Berger.
But both men were “M.I.A.,” according to Brooks. Moore wasn’t at the statehouse, and Berger was apparently unavailable.
“We pay their salaries, their health insurance, and we get blown off,” Brooks said after a brief exchange with aides in Berger’s office. “It’s not fair.”
He was joined at the legislature by a group of supporters, some of whom held signs that read “We Support Anthony” and “Expand Medicaid Now.” One of the attendees, Marilyn Clayton of nearby Glendale, said she decided to participate because she would not have survived a “very serious cancer diagnosis” in 2016 without health insurance.
“I was constantly giving thanks for the fact that I had health insurance that allowed me to continue to live to meet my two grandchildren and to be a part of their lives,” she said. “I feel very strongly about the fact that people like Anthony and so many other people deserve to have health care.”
DeAnna Brandon, a Rowan County resident diagnosed last year with a rare blood cancer, needs the same type of stem cell transplant that extended Clayton’s life. Brandon, who does not have health insurance and is unable to pay for the expensive procedure out of pocket, would qualify for Medicaid under expansion.
But the clock, she told NC Health News during a recent interview, is “beyond ticking.” The chemotherapy Brandon receives to manage her cancer symptoms may eventually cause irreversible damage to her cells, undermining the effectiveness of a transplant.
“With them dragging their feet and taking their time on these decisions, it’s leaving literally my life in the balance,” she said of the General Assembly. “This is the only way for me to buy more time to spend with my friends and family.”
Seemingly simple
The legislature’s unwillingness to decouple expansion from the budget is baffling to the Rev. Lisa Garcia-Sampson of the Unitarian Universalist Justice Ministry of North Carolina.
“It’s writing two sentences to say, ‘Let Medicaid expansion be enacted,’” said Garcia-Sampson, who was among the supporters who rallied behind Brooks at the statehouse. “It does not need to be in the budget. It never needed to be in the budget.”
While seemingly simple, the proposal to carve expansion out of the budget was also time-sensitive. DHHS needed approval from the General Assembly by Sept. 1 to proceed.
“If they had done that 10 days ago, that might have been the difference between Anthony getting this lifesaving heart surgery or not,” Garcia-Sampson said. “As people of faith today speaking to Berger and Moore as fellow people of faith, how can you in good conscience know that this solution is right in front of you to save lives of people all across our state?”
Berger and Moore did not respond to earlier messages from NC Health News seeking comment on the proposed decoupling.
Lawmakers have indicated that a budget could be delivered this week, but the arrival of a spending plan is unlikely to change DHHS’ timeline for launching expansion. Kinsley, the department head, recently told reporters that implementation must be scheduled around complexities such as “quarterly cash flow issues” involving the federal government. Washington covers two-thirds of the cost for Medicaid in North Carolina and will pick up 90 percent of the tab for expansion patients.
The uncertainty surrounding expansion is compounded by the expiration of a federal mandate that prevented states from disenrolling Medicaid participants during the first three years of the COVID-19 pandemic. More than 99,900 people in North Carolina have lost coverage since the state resumed terminations in June, according to data released Monday by DHHS.
Like Brooks, many of those residents would still have health insurance if expansion had gone into effect.
“This is another day that’s passed that somebody is dying,” Brooks said. “We can’t sit here and have purged rolls and people dying […] because they don’t have Medicaid.”
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