No Data, No Problem: Quantifying Latine Individuals Eligible for but Not Enrolled in Medicaid or Affordable Care Act Marketplace-Based Insurance in North Carolina

Populations that identify as Latino/a/e/x or Hispanic (herein referred to as Latine) in the United States continue to face disproportion-ate health and socioeconomic challenges that were exacerbated during the COVID-19 pandemic and persist in the current political climate.^1–3 Long-standing systemic inequities, including precarious employment, fears caused by immigration policy (e.g., variations in the definition of public charge, a term in immigration law that describes individuals who are predominantly dependent on government assistance, influencing their eligibility for visas or residency status), and high uninsurance rates, among other factors, contribute to these disparities.^4–7 Recently, in NorthCarolina, two legislative measures—House Bill 10 (implemented in December 2024) and Senate Bill 153 (passed in March 2025)—have directly targeted immigrant communities by mandating that sheriffs and state agencies collaborate with US Immigration and Customs Enforcement (ICE) without ensuring due process. Furthermore, the escalation of public deportations and the looming threat of cuts to Medicaid fund-ing reflect and reinforce long-standing concerns among Latine and other immigrant populations regarding enrollment in insurance and other public benefits.In this article, we assert that the persistent gaps in insurance coverage among eligible Latine individuals in North Carolina are largely exacerbated by structural barriers and data deficiencies that minimize the appearance of inequities. We first examine the transition from the COVID-19 Public Health Emergency (PHE) to the recentMedicaid expansion in North Carolina to reveal how procedural challenges and systemic distrust have contributed to significant coverage lapses. We then detail the unique obstacles Latine communities face during enrollment, which underscore the need for more precise data collection and culturally informed outreach. Finally, we propose community-informed policy solutions designed to address these challenges.

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