Trisha Byers, a 39-year-old Massachusetts native, faced a pressing issue after moving to North Carolina last year: the loss of her health insurance. Previously enrolled in Medicaid, she found herself unprotected as North Carolina had yet to expand Medicaid under the Affordable Care Act. This lapse resulted in substantial emergency room bills accumulating during her first months there.

In December, however, North Carolina became the 40th state to expand Medicaid eligibility to adults with incomes up to 138% of the federal poverty level, equating to $20,783 for individuals. “I could finally get all the doctor appointments I needed,” Byers shared, representing one of over 500,000 North Carolinians who gained coverage through this change.

The state’s decision to expand Medicaid arrives amid significant shifts in the program’s history. Following the expiration of pandemic-related protections in April 2023, over 24 million people were disenrolled from Medicaid, prompting fears of a nationwide spike in uninsured rates. Nevertheless, more than a dozen states are also moving to enhance health coverage for various vulnerable groups, including children and pregnant women.

While the full impact of these changes remains undetermined, data indicates that the Medicaid unwinding process could mitigate some adverse outcomes. States are still finalizing their disenrollment efforts, and official figures from the U.S. Census Bureau are awaited until next September to gauge the true effect on the uninsured demographic.

Jennifer Babcock, a senior vice president at the Association for Community Affiliated Plans, emphasized the importance of Medicaid within the national safety net. “These expansions are incredibly meaningful,” she stated, referencing the ongoing shifts in Medicaid policies.

Recent expansions across several states further illustrate this trend. South Dakota expanded Medicaid last year, resulting in approximately 22,000 enrollments within eight months. Oregon introduced a new coverage option for adults earning too much for Medicaid, enrolling over 50,000 individuals to date. Additionally, states like California and Oregon have enacted policies to maintain children’s coverage for extended periods.

In a move reflecting a heightened awareness around maternal health, numerous states have broadened eligibility for pregnant women. States like Nevada and North Dakota have made it easier for expectant mothers to qualify for Medicaid, while some, including Maine and Vermont, have lengthened postpartum coverage to 12 months.

With states sharing Medicaid funding with the federal government, economic growth typically drives these expansions. However, heightened attention to maternal mortality rates and pandemic considerations have accelerated the momentum for coverage increases, according to Allison Orris from the Center on Budget and Policy Priorities.

The pandemic underscored the critical nature of health coverage, demonstrating that maintaining insurance enrollment often yields better health outcomes. Yet, as Medicaid’s pandemic-era protections fade, some observers worry that recent gains will reverse. A recent KFF survey indicated that 23% of disenrolled adults became uninsured in 2023, with the Centers for Disease Control and Prevention reporting an increase in the uninsured rate in early 2024.

The unwinding period has witnessed a notable loss, with roughly 14.8 million individuals having been removed from Medicaid rolls. However, some experts believe the uninsured rate might not rise as sharply as anticipated due to recent expansions. “We have seen some amazing coverage expansion in places like Oregon and California,” remarked Ben Anderson from Families USA, highlighting regional disparities in health coverage access.

Despite these advancements, the unwinding process has been notably flawed in several states, resulting in eligible individuals losing coverage due to administrative errors. A report from the Government Accountability Office noted widespread mistakes among states during this transition.

The recent expansions underscore a growing priority placed on health coverage for vulnerable populations. Tricia Brooks from Georgetown University highlighted the need for continuous insurance to ensure children can access regular health providers and thrive in educational settings. However, the political landscape poses uncertainties for future expansions, especially with potential shifts in administration. Advocacy groups like the Progressive Policy Institute remain vigilant, aware of the possible implications for Medicaid coverage should conservatives take a more dominant role in policy-making.