After a month of promoting N.C. Dept. of Health and Human Services’ plan to relieve qualifying North Carolinians of medical debt dating back to Jan. 1, 2014, Gov. Roy Cooper finally saw it realized.
On Friday, the U.S. Centers for Medicare and Medicaid Services approved the plan, in partnership with medical debt relief nonprofit Undue Medical Debt, that will relieve an estimated $4 billion of qualifying residents’ medical debt. Now it is up to Gov. Cooper and NCDHHS to convince hospitals to participate in it.
Cape Fear Valley Health is currently evaluating the governor’s medical debt relief program to determine whether it will participate, Chaka Jordan, vice president of marketing and communications for Cape Fear Valley Health, said.
As one of the county’s largest health provider debates participating in the program, Cumberland County residents can rely on existing medical cost-saving services to minimize their medical debt.
Thirteen percent of Cumberland County residents face unpaid medical-related debts, according to data on medical debt from non-profit data research organization The Urban Institute. People often get into medical debt because of out-of-pocket costs resulting from lack of insurance or having insurance and going out of network for care. Higher costs, though, increasingly result when insurance coverage has high deductible plans — plans that cost less per month but require a person to pay more before the insurance company covers anything. This is often called being underinsured.
“There is a large expectation of out-of-pocket costs for individuals when they go to get medical care and often they can’t pay it,” Allison Sesso, the CEO and president of Undue Medical Debt, told CityView. “That’s the important part: that the amount of money that they are expected to pay doesn’t match their actual means.”
The average Cumberland County resident spends almost $8,300 per year on health care, slightly higher than the state average, according to a 2020 analysis. That is 14% of the county’s median household income. It can be particularly difficult for the 16% of the county living in poverty and almost 11% under the age of 65 still without health insurance, even after the state’s Medicaid expansion last year, to pay for medical care.
“There’s a lot of people in the community that are in the service industry — whether it’s waitresses, daycare workers, school crossing guards, school bus drivers, people with lower income — and their employers do not provide health insurance and they can’t afford it themselves,” Cathy Ory, the executive director of the CARE Clinic, a nonprofit that provides free basic medical, said.
Residents with medical debt have an average total of a little over $600 in past due expenses, with residents of color having on average about $80 more in medical debt than white residents, according to The Urban Institute’s data. While the numbers might seem low, about half of the 2,375 adults in a KFF study said they would not be able to pay a $500 unexpected medical bill without borrowing money.
“If they have to choose between food and going to their medical appointments, that’s a big deal,” said Christiana Adeyemi, the director of BetterHealth, a nonprofit in Cumberland County offering direct aid for medical care.
Since 1958, BetterHealth has provided Cumberland County with health care services ranging from medical equipment loans to funds for prescriptions. To apply, residents need proof of county residency and income and a valid ID. Most importantly, residents can get help the same day. It is one of the few organizations in the county that serves both the uninsured and underinsured.
“People can walk in, say, ‘I need help now. I’m in serious pain,’” Adeyemi said. “We see a lot of people with their teeth infected, their face swollen. You can tell they are in excruciating pain and there’s nobody else to help them out and we’re able to help them out.”
As a medical emergency assistance program, there is a limit to how much BetterHealth can do in the long term. That is when programs like N.C. MedAssist’s Free Pharmacy Program, the county’s Medication Assistance Program and the CARE Clinic can come in. Both the Free Pharmacy program and the Medication Assistance Program help people afford prescription medications. Volunteer doctors and dentists at the CARE Clinic provide basic medical care for the uninsured every Tuesday, Thursday and the second and fourth Wednesday of each month and dental care every Tuesday and second and fourth Wednesday at 239 Robeson St. in Fayetteville.
Cumberland HealthNet also helps with long-term access to care. The 12-year-old nonprofit will help uninsured residents, including those pending Medicaid approval, with certain chronic health conditions navigate the health care system to access insurance and prescriptions. They also run a by-appointment clinic out of the county’s Dept. of Public Health at 1235 Ramsey St. on Mondays and Wednesdays.
“Navigating the health system just for the average person is tough, right?” Shelley Hudson, executive director of Cumberland HealthNet, said. “So, then when you’re looking at the underserved acute communities, it’s even harder for them. So they really do need a navigator that’s with them to help walk them through the process and that’s something that we have.”
For care at Cape Fear Valley Medical Center’s emergency room or services in the health system, cost-cutting options include charity care, discounts for uninsured or underinsured patients, sliding scale discounts for patients of limited means and interest-free payment plans.
No matter what handful of programs or organizations a resident chooses to use to cut down medical costs, Hudson emphasized that there are more options than going to the emergency department, getting stuck with a large bill and possibly going into debt over it.
“The number one reason somebody ends up in medical debt is not related to their insurance rate,” Sesso told CityView. “It’s whether or not they get sick. So, I think it’s actually increasingly making everybody vulnerable.”
CityView Reporter Morgan Casey is a corps member with Report for America, a national service program that places journalists into local newsrooms. Morgan’s reporting focuses on health care issues in and around Cumberland County and can be supported through the CityView News Fund.