Pisgah Legal executive shares insights, guidance on Medicaid expansion

In North Carolina, Medicaid expansion launched Dec. 1, offering coverage to adults, ages 19-64, earning up to 138% of the federal poverty level. Statewide, as many as 600,000 residents are now eligible. Locally, over 6,100 Buncombe County residents signed up on the first day, according to a N.C. Department of Health and Human Services Medicaid dashboard. 

Xpress checked in with Pisgah Legal Services, which helps low-income people sign up for Medicaid and Affordable Care Act medical insurance coverage. We spoke to Jaclyn Kiger, Pisgah Legal’s chief operating officer, to find out how enrollment is going.

This interview has been edited for brevity and clarity.

Xpress: What does the expansion mean in WNC?

Kiger: Dec. 1 was a huge, important day for the state of North Carolina and for so many people that have been waiting for Medicaid. Here in WNC, speaking broadly, we’re talking about people who work in restaurants, hotels, piecing together two or three part-time jobs, artists, cashiers. People who were left out. It opens up really good, quality health care for them. Of our enrollment work during open enrollment, 30% has been Medicaid. That’s huge.

Also, community health centers: They can now bill Medicaid for a larger share of their population. That’s a positive aspect. It means coverage for many, many low-income people who have been without for decades. Ultimately, [the decision to expand coverage] is going to save lives.

What role does Pisgah Legal play in Medicaid expansion?

The enrollment between Medicaid and ACA is similar in that we’re working with people in determining who in their household needs coverage, what their household income is according to the guidelines and regulations, and then supporting them and assisting them in submitting an application, whether it’s through North Carolina’s system for Medicaid, ePASS or through the exchange, which is the marketplace app for ACA. The local department of Health and Human Services is also available. Pisgah Legal is a big part of that network of resources here in WNC. Our services are free and confidential.

Is it complicated to sign up for Medicaid?

It is not. It’s important for readers to know there are free resources across the state to understand their options and support them in going through the enrollment process. I think the state of North Carolina has done an excellent job to roll this out as quickly as possible. Any delay puts people at risk of not having the coverage that they need. 

When can people enroll for Medicaid?

This is an ongoing enrollment, unlike the Affordable Care Act. [ACA enrollment ended Jan. 16.] Medicaid is year-round. I think that will change the workflow.

Are there some people who are unhappy that the expansion enrolled them in Medicaid and threw them off their ACA coverage?

I think there is a lot of education about what that means and what Medicaid offers. There is a small overlap of people who were over 100% for the federal poverty income levels and under 138% [that qualified for ACA coverage]. Medicaid is an outstanding safety net health care program here in the state of North Carolina and across the country. So what we’ve done at Pisgah Legal is make sure there is education and understanding about what is Medicaid.

Medicaid has a maximum copay of $4, with many services requiring no copay at all. It also provides dental coverage for adults. And it has other pieces, like nonmedical transportation, which is something that is outside of ACA plans.

We have heard that there have been some challenges with finding providers that take Medicaid. That is true. But we have heard from the state that they expect more providers to sign up. 

Do you help providers get set up to accept Medicaid payments?  

No, our role is the access to getting on Medicaid — the eligibility and understanding your rights and what’s covered under Medicaid. On the provider side, there is an ombudsman program.

Is Medicaid expansion available to everyone who qualifies?

Unfortunately, no. There will still be vulnerable populations that are left out. …  Many immigrants will qualify for Medicaid or ACA, but for [those who are] undocumented, it may be complicated. Please call us. 

Does Pisgah work with the immigrant population in accessing community resources that are available to them?

Yes. We have a Justice for All program on the civil legal side. People can reach out to us about immigration laws, housing, domestic violence and other issues. 

Are there resources for immigrants regarding health care who don’t qualify for Medicaid or ACA?

It’s very limited. 

Can unhoused people get coverage?

Yes. That is a population that we are working with. 

What is the primary message you want to get out into the community about who is and who isn’t eligible for Medicaid?

To people who are reading this and don’t have health insurance, I really urge them to reach out to Pisgah Legal so we can talk about what options may be available. Maybe they haven’t been insured and they don’t think there is a program out there that meets their needs or that they can afford. It’s certainly worth connecting to Pisgah or another community resource [to find out].