There’s been a lot of talk of late emanating from the McCrory administration about “expanding Medicaid.” Unfortunately, a close look at the fine print makes clear that the minor proposed “expansion” has absolutely nothing to do with closing the state’s massive Medicaid coverage gap that has resulted from our failure to expand the program under the terms of the Affordable Care Act.
Both the North Carolina Medicaid and NC Health Choice Draft Section 1115 Waiver application written by the state Department of Health and Human Services (DHHS) and included in the Governor’s 2016-2017 proposed budget presentation use the word, “expansion,” freely. Unfortunately, neither the Governor nor DHHS have committed to closing the coverage gap or truly expanding Medicaid so that nearly one-half million North Carolinians can have access to health services. To be clear, closing the coverage gap means extending health coverage to individuals at or below 138 percent federal poverty level, which is an annual income of $16,394 for an individual and $33,534 for a family of four in 2016.
The 1115 waiver is for Medicaid “reform,” NOT Medicaid expansion. As you may recall, DHHS and the General Assembly want to transform our current nationally recognized primary case management system to managed care, where both commercial insurers and “provider led entities” would administer Medicaid services.
The waiver proposal reports that North Carolina will embark upon a tiny “expansion” of Medicaid whereby parents whose children enter the foster care system can access health care services in order to strengthen family stability. Unfortunately, this “expansion” is only for parents who already meet income eligibility for Medicaid when their children are in the home. Currently, once their children are removed from the home, parents previously enrolled lose their benefits. In other words, while welcome, all the proposed change does is alter a minor, extremely illogical rule.
What’s more, there are many other uninsured children who may never enter foster care, but still do not receive health care because their parents do not have access to health coverage. Closing the coverage gap to all individuals would help more than 140,000 children access health care — something that is associated with increased education attainment, enhanced earning potential, and fewer emergency department visits later in life.
Like the “expansion” in the 1115 waiver, other Medicaid “expansion” initiatives proposed by the Governor lately — such as enhancing services for people with Alzheimer’s disease, developmental disabilities, and substance use disorders — are much needed. Unfortunately, these enhanced services still ignore the fact that over 25,000 people are not receiving proper medication to help their diabetes, nearly 1,000 people in North Carolina die unnecessarily because they lack access to health care, or that nearly 15,000 families experience financial stress due to medical bills.
In other words, the changes are welcome, but not even close to what is really needed. To address the suffering of their constituents, it’s past time that they heed the widespread agreement by more that 72 percent of polled North Carolinians that “North Carolina should make a plan to fix the health insurance gap” and do it now.