Tomorrow, the state House and Senate are expected to come to a compromise on what will be their first piece of legislation in response to the COVID-19 crisis, exactly two months after North Carolina’s first case was detected on March 2.
While life has changed for all North Carolinians, some have been more exposed to the dangers posed by the coronavirus pandemic due to policy choices that have blocked people from accessing health care, depleted the public health infrastructure, weakened the social safety net, and diverted money away from communities.
These choices and others translate into health disparities that are putting some in greater danger due to COVID-19 because their limited employment opportunities put them at higher risk of exposure, they have chronic conditions that make them more susceptible to the severe impacts of the disease, and structural inequities make it less likely that they will receive the care they need. The result is that African Americans are disproportionately contracting and dying from COVID-19 in North Carolina. In other areas around the country, Latinx and American Indian populations are also dying at disproportionately high rates given their relative share of the population.
Now is the time to make the investments in public health infrastructure, supports for communities who have been blocked from accessing care, school nutrition, COVID-19 research, and supports for hospitals so they can continue to serve their communities. Here’s how the House and Senate proposals to date compare:
In addition to the funding, there are other key provisions that differ across the bills.
- The House bill would provide targeted Medicaid coverage for COVID-19 prevention, testing, and treatment to individuals up to 200 percent of the Federal Poverty Level, though this is subject to approval from the federal Centers for Medicare and Medicaid Services (CMS).
- Only the House version of the bill would require the NC Department of Health and Human Services to adhere to federal regulations needed to receive the enhanced Federal Medical Assistance Percentage (FMAP), also known as the federal Medicaid match. These regulations include providing continuous coverage and not terminating anyone from the Medicaid coverage except in a few specific situations, providing coverage for a vaccine and treatment once available with no cost-sharing, and not imposing more restrictive requirements such as higher premiums or eligibility requirements during the period of the public health emergency.
- Both the House and Senate version would authorize the NC Department of Health and Human Services to provide Medicaid coverage to uninsured individuals for COVID-19 testing, at the expense of the federal government, as enacted in the Families First Coronavirus Response Act.
- Both the House and Senate version provide an additional 5 percent increase to providers, as requested in a Medicaid 1135 waiver. However, the House version would provide an additional 5 percent increase for fee-for-service Medicaid rates.
There are many provisions that would strengthen these bills by allowing more North Carolinians to get the necessary care they need, not only for COVID-19 but also for the conditions that put them at greater risk of the disease’s severe impacts, including as diabetes, heart disease, and obesity.
- Expanding Medicaid by providing comprehensive and affordable coverage to over 500,000 North Carolinians has long been overdue in the state and should serve as one of policymakers’ key tools to mitigating the harm of this pandemic. In addition to saving lives, it would help hospitals stabilize their finances while the pandemic has disrupted their normal operations and therefore their ability to remain open and provide necessary care.
- Increase funding allocations so that agencies can quickly allocate funds necessary to meet the demand for services and infrastructure to conduct and oversee the services. In addition, state and local agencies are adapting to the need for remote work, as possible, due to the need for physical distancing. Improved technology infrastructure is likely to be necessary to conduct internal operations and to adapt to the need for remote public-facing work, such as WIC remote benefit issuance.
Beyond this first piece of state legislation, lawmakers should shift to quickly crafting a more comprehensive piece of legislation that takes into consideration the many areas underfunded and absent from the ones considered this week.
Suzy Khachaturyan is a Policy Analyst at the Budget & Tax Center at the North Carolina Justice Center.