By Phil Galewitz, KFF Health News Trisha Byers left behind one crucial item when she moved to North Carolina last year to be closer to her family after suffering a brain injury: health insurance. In Massachusetts, Byers, 39, was enrolled in Medicaid, the government health program that covers low-income people. But she was ineligible in North Carolina, which had not yet expanded Medicaid coverage under the Affordable Care Act.
She said she racked up thousands of dollars in unpaid emergency room bills while uninsured for several months after her move. Then in December, North Carolina joined 39 other states and Washington, D.C.
, in widening Medicaid eligibility to include adults with incomes up to 138% of the federal poverty level, or $20,783 for an individual. “I could finally get all the doctor appointments I needed,” said Byers, one of more than 500,000 North Carolinians who gained coverage. The North Carolina expansion came amid the biggest upheaval in Medicaid’s nearly six-decade history.
Since April 2023 — when protections that had blocked states from disenrolling Medicaid beneficiaries during the pandemic expired — states have disenrolled more than 24 million people whom they said no longer qualified or had failed to renew coverage. This Medicaid “unwinding” led to fears that the number of people without insurance would spike. But it also coincided with moves in more than a dozen states to expand health coverage for lower-income people, including children, p.