Informing North Carolina’s COVID-19 Pandemic Response: Projected Service Needs of Medicaid Beneficiaries.

The COVID-19 pandemic that began in early 2020 precipitated an unemployment crisis in the United States already worse than that of the Great Recession within the first three months of the pandemic, creating massive loss of health insurance coverage since a majority of Americans under age 65 receive coverage through employer-sponsored insurance. Racism and social disadvantage play a key role in the effects of the pandemic, amplifying pre-pandemic disparities in social drivers of health.

In this project, we built upon limited early evidence of the relationship between the COVID-19 pandemic and health insurance coverage by focusing on North Carolina, the third-largest state not to expand Medicaid. We use county-level Medicaid enrollment and unemployment data obtained from the North Carolina Departments of Commerce and Health and Human Services paired with data on county social vulnerability, COVID-19 case burden, and access to social service agencies. Our goal was to understand the relationship between rising unemployment and Medicaid enrollment, and how county social context affected it.

We also examined the health care use and costs using enrollee-level data, looking at how the new enrollee population changed during the pandemic and whether there were any disparities in health care use. Our findings will have implications for the health equity and the state budget in North Carolina, informing both the recovery from the pandemic and how policy can adapt in preparation for future crises.