Access to healthcare

The North Carolina Black Alliance believes every American should have access to health care in time of injury or illness. We are committed to the adoption of universal access to healthcare for all Americans and for improving the quality of care and availability of healthcare professionals in Black and low wealth communities. Learn more about our commitments.

Access to Healthcare: What You Need to Know

black maternal health

Black maternal Health in NC

The Black maternal health crisis is an access to healthcare issue. Access to quality maternity care is a critical component of overall maternal health and helps to produce positive birth outcomes. Black women are 3 to 4 times more likely to die during childbirth.

Medicaid insurance

Medicaid coverage gap

North Carolina has one of the largest uninsured populations in the United States. The coverage gap refers to people who earn too much to qualify for Medicaid, but not enough to get help in the private insurance marketplace.

hands holding paper family cutout

managed care in NC

As of July 1, 2021, most Medicaid beneficiaries began receiving services via NC Medicaid Managed Care. Under managed care, the state contracts with insurance companies, which are paid a predetermined set rate per enrolled person to provide all services.

Black Female doctor

COVID response

The COVID pandemic has disproportionately affected the Black community. The North Carolina Black Alliance has been committed to doing our part by providing credible information that will protect you, your family, and OUR community.

Health Care Access and Medicaid Expansion Historical Timeline

Medicaid creates affordable access to healthcare for low-income families that qualify. However, many families still fall within the coverage gap. The coverage gap refers to people who earn too much to qualify for Medicaid, but not enough to get help in the private insurance marketplace. While the federal government establishes parameters for all states to follow regarding Medicaid, states maintain autonomy for the administration and operation of their Medicaid programs. This historical timeline highlights pivotal decisions in the creation, expansion, and privatization of Medicaid in North Carolina.


Initial Launch and Creation of Health Resources in North Carolina

    • The Social Security Act of 1965 creates Medicaid alongside Medicare, expanding access to health coverage for low-income individuals. North Carolina officially launched Medicaid in 1970 and began enrolling those who qualify. 
    • Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) was also created by the Social Security Act of 1965, to give children under 21 who are Medicaid eligible, access to age-appropriate healthcare screenings. 
    • In 1973, the Office of Rural Health opens, becoming the first state office in the nation created to focus on the needs of rural and underserved communities. 
    • In 1983, the General Assembly charters the North Carolina Institute of Medicine (NCIOM), to be a non-political source for guidance and analysis on major health issues in the state.


    The First Medicaid Expansion

    • EPSDT screenings were expanded under the Omnibus Budget Reconciliation Act to provide coverage for disabled children in 1989. 
    • During this time, Medicaid expands to include pregnant women and children under 6. 
    • In 1995, additional Medicaid Expansion occurs through General Assembly legislation to cover older adults and people with disabilities who were receiving Supplemental Security Income. 
    • In 1996, limitations are placed on large group health plans, preventing them from imposing annual or lifetime dollar limits on mental health benefits that are less favorable than any such limits imposed on medical/surgical benefits.
    • The Kate B. Reynolds provides funding for health services in rural communities, creating the North Carolina Rural Health Center in 1996.


    Mandatory Expansion Ruled Unconstitutional

    • The American Recovery and Reinvestment Act in 2009 provides $87 billion for two years to help states pay for the additional Medicaid needs that usually occur in recession. The Act also allocates $24 billion to clever 65% of COBRA premiums for up to nine months for laid off workers. 
    • In 2010, the Affordable Care Act (ACA) becomes law under President Barack Obama. This transformative legislation allowed for young adults to remain on their parents’ insurance until age 26. It also required states to expand Medicaid to childless, able-bodied adults up to 138% of the Federal Poverty Level (FPL). 
    • While the ACA created greater consumer protections for health coverage and expanded affordable access on the healthcare marketplace, many were still left in the coverage gap. 
    • In 2012, the Supreme Court declared mandatory Medicaid expansion unconstitutional, making expansion optional for states. 
    • In 2016, enrollment reached a high of 613,487. However, at this time North Carolina chooses to not expand Medicaid.


    Privatization of Medicaid

    • In 2021, North Carolina privatized Medicaid, moving to a Managed Care system with private insurers administering coverage instead of the state paying medical providers directly. 
    • Instead of expanding Medicaid, North Carolina’s 2021-2023 fiscal budget allows for the creation of a Joint Legislative Committee to study Access to Healthcare and Medicaid Expansion. 
    • In 2022, the American Rescue Plan enhances premium subsidies, extends enrollment period, and increases federal funding for enrollment assistance and outreach, allowing North Carolina to reach a record high of 670,223 people enrolled in private individual market plans.

    access to Healthcare News

    North Carolina Black Alliance (NCBA)
    P.O. Box 27886 | Raleigh, NC 27611 | 919-891-9788

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