Changes coming to Medicaid starting Oct. 1

Changes to Medicaid from last year's Big Beautiful Bill Act are set to take place Oct. 1, leaving Macon County Social Services scrambling to prepare for implementation. The N.C. Department of Health and Human Services put out materials overviewing the changes for local managed care entities like Vaya Health, county departments and members of the public to get a general understanding of the changes that will need to be made. Some people may not be able to keep their insurance due to the changes. State documents say the changes will affect some non-citizens and adults 19-64. For immigrants, only certain individuals will have access to Medicaid coverage: lawful permanent residents, children up to age 19, women who are pregnant or up to 12 months postpartum, individuals with Cuban and Haitian entrant status and citizens of Micronesia, Marshall Islands or Palau living in the U.S. All other non-citizens who were previously eligible for Medicaid will "lose Medicaid coverage, including the ability to go to the doctor, get prescriptions or receive mental health, dental and other services" on Oct. 1. NCDHHS clarifies some non-citizens may qualify for "Emergency Medicaid" if they meet highly specific citizenship, residency and income requirements. Those concerned should contact the Macon County Department of Social Services at 828-349-2124 for more information. Adults 19-64 who do not have a documented or recognized disability, who are not pregnant or less than 12 months postpartum, who are not parents of a child under age 14 or with disability and who do not qualify for other exceptions or exclusions must prove they spend at least 80 hours per month working at a paid job or work training program, volunteering, attending school at least part-time, earn at least $580 per month per household, or be a seasonal worker with at least $580 per month on average for the last six months. A supervised job search can count as work, and volunteering must be undertaken through a structured nonprofit or public organization. Local social services departments can confirm which activities count for the requirements. Exceptions are carved out for individuals who qualify for Medicare, who receive Supplemental Security Income or Social Security Disability Insurance, and individuals who are incarcerated in the last three months. Other exceptions are made for those who are "medically frail," participating in addiction treatment or rehabilitation programs, veterans with a 100% disability rating, members eligible for Indian Health Services, Foster and Former Foster Care Youth under age 26, inmates and members of other work-requirement programs like the Supplemental Nutrition Assistance Program and the Temporary Assistance for Needy Families program. Recipients also will need to renew their coverage twice as often – every six months instead of every 12 months – and keep comprehensive documentation to prove their eligibility, including volunteer and work hours for three of those six months. NCDHHS advised Medicaid recipients or applicants to visit the N.C. Medicaid website at medicaid.ncdhhs.gov to find out if they qualify for exceptions or exclusions. Those who do not should save their pay stubs, school records and volunteer logs to share with Macon County DSS. Applicants should also make sure their contact information with their local DSS is up to date so they can collect timely information and respond to mail as quickly as possible. Retroactive Medicaid coverage also changed. Where applicants used to be eligible for bills and expenses incurred up to three months before their application was submitted, starting in 2027 for most members the time will be reduced to costs incurred one month before application. For children, adults 65 and over and those with disabilities, retroactive coverage will cover two months of costs instead of the previous three. NCDHHS encourages those looking to learn more about the impending changes to visit medicaid.nc.gov/changes. Macon County DSS Beneth Aiken, interim director of Macon County Social Services, spoke at the Sept. 10 Behavioral Health Task Force meeting to discuss the impact of the changes to the department coming Oct. 1. Primarily for the department, there will be an increased need to process applications, renewal requests and the associated documents the federal government's unfunded mandate, for which the department will need to request two new positions from the county. "We have six workers that process Medicaid applications for family and children services. We have nine workers that process applications for adult Medicaid. We currently have two openings right now – which is a low amount. Over the last several years we ran about six vacancies at a time … so it's good that we only have two openings, but we still are going to need more positions in order to implement the changes that are coming." With 8,000-9,000 residents to be affected by the changes, Aiken said many will lose their eligibility when the new work requirements go into effect. She said department staff are currently trying to educate recipients on what the changes are and will be so they can respond accordingly, but state educational materials are not always as clear as they should be and enrollees can become frustrated at the lack of clear answers. "Medicaid is very complicated. It's one of the reasons why it's so hard to keep workers to process these applications, because there's always changes. Every day there's a new change," she said. "Within the first few months we should be able to see how it's really going to impact the workload, and hopefully by then we'll be able to get some more staff to help." Greta Metcalf, clinical director at the youth restorative justice nonprofit HIGHTS, said it would be difficult for the nonprofit to connect with their members to ensure they are able to find part-time work or volunteer opportunities to ensure they continue to meet the requirements to keep their medical insurance. Celeste Ordiway, vice president of behavioral health and IDD network operations at Vaya, said, "I think it's important to help people stay on Medicaid and anything we can do to keep people connected with jobs, connected with their DSS offices to make sure that they're completing paperwork helps keep them healthy and keep them in the services that they need." Reporter Shelby Powell can be reached at reporter@thefranklinpress.com.

Changes coming to Medicaid starting Oct. 1

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