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Home My WebLink AboutAgenda - 03-18-2025; 7-a - Medicaid Expansion in Orange County One Year After Implementation 1 ORANGE COUNTY BOARD OF COMMISSIONERS ACTION AGENDA ITEM ABSTRACT Meeting Date: March 18, 2025 Action Agenda Item No. 7-a SUBJECT: Medicaid Expansion in Orange County One Year After Implementation DEPARTMENT: Social Services ATTACHMENT(S): INFORMATION CONTACT: PowerPoint Presentation Lindsey Shewmaker, 919-245-2817 PURPOSE: To receive an update on Medicaid Expansion in Orange County one year after initial implementation. BACKGROUND: State lawmakers approved legislation in early 2023 that called for Medicaid expansion in North Carolina, and then-Governor Roy Cooper signed it into law in March 2023. On December 1, 2023, the legislation went into effect in North Carolina expanding Medicaid access to more North Carolinians. Medicaid now covers people ages 19 through 64 years with incomes up to 138% of the Federal Poverty Level. This is about $20,000 for an individual and about $34,000 for a family of three. Medicaid provides comprehensive medical coverage including services like primary care, maternity care, hospitalizations, prescription drugs, and hearing and vision. Those previously receiving full Medicaid coverage under other programs were not affected by these changes and have continued receiving services. Orange County Social Services staff worked hard to prepare for and implement the expanded Medicaid program in Orange County. In FY 2023-2024 the Orange County Board of County Commissioners approved the creation of nine (9) new, permanent positions to support the increased workload. Social Services staff developed plans for hiring, training, and rollout of the new program and began taking applications on December 1, 2023. As of December 31, 2024, more than 4,600 Orange County residents have been enrolled in the new Medicaid program. FINANCIAL IMPACT: There is no financial impact associated with receiving this update. ALIGNMENT WITH STRATEGIC PLAN: This item supports: • GOAL 2: HEALTHY COMMUNITY OBJECTIVE 2. Expand access to quality, affordable healthcare services. 2 OBJECTIVE 3. Provide social safety net programming and the resources needed for our most vulnerable community members. RECOMMENDATION(S): The Manager recommends that the Board receive the update on implementation of Medicaid expansion in Orange County and provide any comments or questions. 3 ORANGE • NORTH . .O Medicaid • Orange County, NC Board of County Commissioners March 18, 2025 ORANGE COUNTY DEPARTMENT OF SOCIAL SERVICES 4 0 0 0 0 Background Orange County Outreach Events Demographic Timeliness and Federal Changes Questions Expansion Data Data Accuracy and Possible Impacts • • ORANGE COUNTY DEPARTMENT OF SOCIAL SERVICES 5 Background : M ' • . • in Orange County Medicaid Recipients by Category • There are currently (February 2025) 21 ,367 Orange County residents 2zro receiving Medicaid • Medicaid currently covers pregnancy through end-of-life care • North Carolina's Medicaid program 5% 47% covers several optional services in addition to federally mandated 7% coverage and is considered excellent health insurance • $170,400,638.46 in Medicaid 19% expenditures for Orange County residents in SFY2024 ■Children ■Older Adults and Adults with Disabilities ■Adults with Children ■Family Planning ■Expanded Medicaid i ORANL:E('(]tl N'IY DEPARTMENT OF SOCIAL SERVICES 6 Expanded Medicaid in Orange County • Social Services began taking applications for expanded Medicaid (MXP) on December 112023 • Orange County DSS hired 9 additional staff to manage the new program • There were a large number of initial applications that staff worked hard to process • By the end of December 2024, 4,603 Orange County residents were covered by the new, expanded Medicaid program (MXP). This is 86% of the estimated enrollment in Orange County in Year1 ORANGE COUNTY DEPARTMENT OF SOCIAL SERVICES 7 Total MXP En • • e County by • Orange County Medicaid Expansion Enrollment 6000 4603— 5000 3,502 3793 3929 3,017 3,253 3711 I 4068 4181 4283 4419 2,789 4000 2512 � 2101 3000 1 2000 1000 0 November, December, January,2024 February, March,2024 April,2024 May,2024 June,2024 July,2024 August,2024 September, October, November, December, 2023 2023 2024 2024 2024 2024 2024 ■Orange County Medicaid Expansion Enrollment ORANGE COU N'IY DEPARTMENT OF SOCIAL SERVICES 8 Orange County MXP Recipients February 2424 o ne °�" S'A,. _ � �ti1lL RM1�CRs,4IM1I�ICh fr: } yfi*Hy Orange C •MXP Recipients k r ` n through tsF {lis 2 February 1 -; 15" -City Llmks ! ETJ `~` r N}XP Recipients Density - � R �n•iman Spar" Dense •n••^•,e.,d Ir�..�rKpF�m=��.1nc1 ow Kc.E couNn DEPARTMENT OF SOCIAL SERVICES 9 Orange County MXP Recipients December 2024 December 2024 R Orange County MXP Recipients through `y � 15 Sol 'MXP Spare Per�ily -Uj LlmllB ,� N I� Sparse 0 LTJ �..., Dwse ` ow,rrc.E couNn DEPARTMENT OF SOCIAL SERVICES 10 Demographic O • NCDHHS built a Medicaid Expansion Dashboard and updates data monthly https://medicaid.ncdhhs.gov/reports/medicaid-expansion-dashboard • In the first year of enrollment, Orange County residents receiving MXP were mostly: Ag_ . . White/Caucasian Female Not Hispanic In Chapel HilLsborough see ORANGE COUNTY DEPARTMENT OF SOCIAL SERVICES Outreach Efforts and Events Southern Orange County and Southern Orange County and Northern Orange County and Mt.Zion AME Church ORANGE COUNTV E)EPARTMENT OF SOCIALSERVICES Rogers-Eubanks Community Center Estes Park Apartments Jones Grove Church CHCCS Fairview Park Cedar Grove Community Center White Cross Fire Department Collins Crossing Apartments Orange Middle School UNC Mebane Chapel Community Health and Wellness Events Carrboro in Motion Events Justice United Lee's Chapel 12 Timeliness and Accuracy Measures Medicaid Report Passed every month in 2024 Card 95-99% timeliness in 2024 Recipient Passed every month audited in 2024 Eligibility Determination 90-100% accuracy in 2024 Audit (REDA) • • ORANGE COUNTY DEPARTMENT OF SOCIAL SERVICES 13 Orange County's Medicaid Expansion Team d l� 1� 4 I From left to right:Julie Cates, Kizzy Laws,April Martindale,John Beasley, Louise Moize Shawntia Dawson,Cathia Ortiz, Muriel Hickman-Dixon E)RANM Not Pictured:Angie Dinarte DEPARTMENT OF SOCIAL SERVICES 14 Federal Changes and Possible Impacts • Work requirements • Estimated 47% of North Carolina Medicaid enrollees would be impacted by work requirements* • Cessation of waivers • North Carolina currently has 7 waivers either approved or pending approval • Includes 1915b waivers (Innovation) and 1115 waivers that would provide ongoing coverage for children • Block grant/Funding reduction • Reduction of services • Reduction of coverage groups • Federal Medical Assistance Percentage changes • • • *Medicaid Work Requirements Could Put 36 Million People at Risk of Losing Health Coverage I Center on Budget and Policy Priorities ow ORANGE COUNTY DEPARTMENT OF SOCIAL SERVICES Optional Medicaid Covered Services and Groups in North Carolina 16 Federal Medical Assistance Percentage Changes • When Medicaid Expansion legislation (NC Session Law 2023-7) was written in North Carolina, it included specific provisions related to the federal medical assistance percentage (FMAP). If this rate falls below 90%, Medicaid coverage for the expanded population in North Carolina "shall be discontinued as expeditiously as possible" • This would cause the loss of benefits for most of the 4,600 Orange County residents enrolled in expanded Medicaid • It would also increase uncompensated care for providers, including UNC Health, Orange County Health Department, Orange County Emergency Services, pharmacies and other medical providers ORANGE COUNTY DEPARTMENT OF SOCIAL SERVICES 17 Questions? Lindsey Shewmaker, Director lshewmaker@orangecountync.gov Louise Moize, Human Services Supervisor lmoize orangecountync. ov • • ORANGE COUNTY DEPARTMENT OF SOCIAL SERVICES