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States Without Medicaid Expansion Search for Alternatives

John Commins, for HealthLeaders Media, August 27, 2014

It's difficult to overstate the effect of losing tens of billions of dollars in healthcare funding, and not just on state budgets. Now those leaders who opted out of Medicaid expansion are falling back on an old ploy: When in trouble, form a committee.

A task force in North Carolina this month issued recommendations for improving health outcomes in its 2.2 million residents living in rural areas.

In many respects, the report issued by the  North Carolina Institute of Medicine Task Force on Rural Health identifies the problems in healthcare access and delivery that challenge many rural areas in states across the nation.  

"Priorities" identified in the report include: improving job prospects and investment in rural areas; improving access to school readiness programs and quality daycare for children; improving nutrition education; using primary care to screen for mental health and substance abuse; and incentivizing healthcare providers to settle in rural areas.

Left all but unmentioned in the report, however, was the wooly mammoth in the room. North Carolina is one of 24 states that rejected the Medicaid expansion and the tens of billions of dollars in federal funding that come with it.

The Urban Institute issued a study this month which showed that the decision by state lawmakers and the governor of North Carolina to reject Medicaid expansion would mean the loss of $40 billion in federal funding from 2013-2022. In addition, 414,000 mostly working poor North Carolinians who would otherwise have qualified for Medicaid, will have to find coverage elsewhere if they can afford it.

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