NC Cannot Easily Verify New Medicaid Eligibility Requirements

Officials from the North Carolina Department of Health and Human Services (DHHS) recently sent a report to the General Assembly. DHHS reported how difficult it will be to regularly verify Medicaid non-exempt beneficiaries.

North Carolina Medicaid is supervised by DHHS but administered at the county level to determine eligibility. The 100 county Departments of Social Services (DSSs) conduct eligibility determinations for:

• Food and Nutrition Services (FNS)

• Women, Infants, and Children Supplemental Nutrition Services (WIC)

• Supplemental Nutrition Services

• Temporary Assistance for Needy Families (TANF)

• Low Income Energy Assistance Program (LIEAP)

• Child Support enforcement

• Other means-tested and social programs

NC Medicaid implemented automated data matching and verifications to successfully reduce this administrative burden. It recently processed an additional 700,000 beneficiaries through Medicaid expansion. DHHS reports that the new guidelines will significantly increase county administrative burden, increase staffing and costs, create backlogs in unprocessed cases, and increase overall program expenditures. It expects the following impacts due to the new guidelines:

• North Carolinians will have to provide more information, more often to show compliance or exemptions.

• Providers will receive increased requests for medical documentation to support exemption requests and disability determinations

• Anticipate North Carolinians will move from expansion to traditional Medicaid, potentially increasing participation and costs for traditional Medicaid (Expansion does not cost NC any state dollars)

• DSS offices will absorb both complex new work requirements and more frequent eligibility determinations

• As North Carolinians navigate changes, the General Assembly is likely to receive increased outreach from constituents with questions and concerns about the new requirements.

DHHS estimates the additional cost burden on the state will be:

• $31.2 million per year to support county eligibility determination functions;

• $6.5 million for state start-up costs;

• $13.2 million per year for ongoing state administrative costs;

• Additional state start-up costs for system changes to support automation (where possible) and member outreach and education; and

• State ongoing vendor fees for income verification and system operations.

  
  

Note that state investments will be met with federal matching grants (up to 90% for system development and up to 75% for system operations).

For more information, read DHHS's report here.