Medicaid Expansion in NC Could Help Thousands of Farmers

On December 1, 2023, Medicaid expansion went into effect in North Carolina, effectively closing the health insurance coverage gap for people in the middle incomes who make too much for Medicaid, but too little to qualify for a subsidy on the Affordable Care marketplace. There are 600,000 people in North Carolina in that coverage gap. Peg O’Connell is chairperson of Care4Carolina, an organization that played a role in getting Medicare expansion in the state. Peg tells SFN farmers make up a large portion of those in the coverage gap.

We find that our farmers were uninsured as far as health insurance. And so they you know at the end of the day, they would say am I going to pay my workers am I going to pay myself? Am I going to buy a tractor or am I going to pay a lot of money for health insurance, and most chose not to buy health insurance. So this is a big deal for farmers.

O’Connell is quick to point out that Medicaid is not a government handout.

Every person in North Carolina for the last 10 and a half years has been paying a tax to the federal government to support expanded Medicaid expanded health insurance in Virginia, in California, and in New York. And so North Carolinians finally have the opportunity to sign up for this. These rugged individualists need to be strong, and they need to be healthy, and having access to health insurance and the ability to see the doctor is going to let them stay that way.

She says there’s two ways to sign up.

There is a website,, and all they have to do is go there. They will have to provide income information from their tax documents. Then they just fill out the questions that are asked. It’s not terribly complicated, and they press Send and then they will know very soon whether they can be enrolled. If there are questions somebody will follow up with them.

O’Connell says if you have questions you can see someone in person as well.

All over the state of North Carolina in addition to this, so if any they’re like me and they hate signing up on for anything on a website, there are navigators that will help them actually navigate this whole thing. And there are enrollment events going on across the state where people can go in and sit down and have somebody who knows what they’re doing, help them fill out the forms and get the process moving.