Medicaid Expansion in North Carolina: What Practices Can Expect

December 8, 2023

By Rebecca Cooper, Policy Specialist

Medicaid Expansion has officially passed and was implemented in North Carolina on December 1, 2023. This makes North Carolina the 41st state to expand Medicaid, and the first state to expand Medicaid in a post-Public Health Emergency, post-Medicaid redetermination environment. Experts estimate that nearly 600,000 people may have new or expanded access to coverage, but without a strong coordinated effort to inform patients of their newly eligible status, this will mean very little. 

Medicaid expansion is linked to gains in coverage and access to health care for patients, generally resulting in improvement in health, as well as economic benefits for clinicians. 

In the wake of Medicaid redetermination

In North Carolina, nearly 70,000 patients lost coverage due to administrative errors. Across the country, patients missed information, received mixed messaging and were confused. In an effort to cut down on some of the communication challenges, Aledade sent over 54,500 texts to patients throughout the nation, notifying them to check their Medicaid status. 

Even prior to the pandemic, Medicaid churn – or beneficiaries temporarily losing Medicaid coverage because of administrative barriers – was a major challenge that caused disruptions in care, worse health outcomes and inefficient, rising health care costs. Research shows that 11.2% of full-benefit children and 12.1% of adults lost coverage in 2019, just to gain it back in 2019.

In North Carolina, Medicaid Expansion provides an opportunity for beneficiaries to gain (or re-gain) access to health care in order to receive primary care and preventive services in a more efficient, regular way.

Who and what is covered under Medicaid expansion?

Medicaid Expansion in North Carolina will cover several populations that change the demographics of those traditionally insured by Medicaid.

People of all ages and ethnicities will have new access to Medicaid through this expansion. Research shows that in North Carolina, Black people will see the highest reduction in uninsurance at 6%; and White and Hispanic people will see uninsurance rates decline around 3%. Undocumented immigrants still do not have access to Medicaid in North Carolina. 

Coverage will be comprehensive and comparable to commercial coverage, including primary care services, behavioral health, maternity and postpartum care, prescription drug benefits and more. 

What can practices expect to see?

With nearly 600,000 people expected to gain coverage, many state officials and health care personnel are concerned about a lack of availability and workforce overload for their practices. Importantly, not all 600,000 people gained access immediately on December 1, as it will take time for beneficiaries to apply for coverage and have their applications processed. However, 300,000 people who are enrolled in Medicaid’s limited family planning program through their local Department of Social Services (DSS) became eligible to receive full coverage on December 1. For practices that already accept Medicaid patients, North Carolina Department of Health and Human Services (NC DHHS) officials recommend preemptively having some telehealth visits or new-patient visits available for an increased demand. 

This new Medicaid population will likely need more guidance and encouragement to go to you – their primary care office – first, instead of the ER, for minor concerns.

For consideration: Does your practice accept Medicaid patients? Are you prepared from a workforce and workflow perspective to accept more? Do you have availability for same day access, telehealth, meeting with a new patient? What further information do you need to make this transition as easy as possible for your practice? 

If you are a currently enrolled Medicaid clinician, check to make sure your information is correct in NCTracks, including whether you are accepting new patients. For more information about the managed change request process, please see NCTracks.

Aledade is working to help close coverage gaps and ensure sustainable access to quality care for patients today.

Aledade is a convener in North Carolina. We partner with four of the five Medicaid managed care plans; if a patient switches from Medicare to Medicare Advantage, we have them covered. If they switch from Medicaid to a commercial plan, we have them covered. Maintaining and nurturing a strong patient-clinician relationship is critical to primary care. Accountable care models are based on the concept that clinicians accept accountability for managing the full continuum of care for their patients. 

North Carolina State Resources 

The NC Department of Health and Human Services has a host of materials that practices can use to spread the word about Medicaid Expansion.

Aledade has been actively involved with other states who implemented Medicaid Expansion. Stakeholders who were involved cite the importance of partnerships, including convening medical providers and community-based partners to ensure all constituents receive important information relative to their eligibility, benefits and services, and workforce support.

Aledade will work with NC DHHS and our health plan’s partners to support patients. Aledade member practices can reach out to the policy team ( and the Medicaid team ( with questions.