NC Budget and Tax Center, public health

Analysis: 5 reasons a Medicaid work requirement would hurt North Carolina’s struggling families

Lawmakers in Congress and in North Carolina’s General Assembly are considering “work requirements” in Medicaid as part of an overall health care reform package. However, evidence shows that denying medical care to sick, poor people because they lack a job is not a good idea.

Here in North Carolina too many families across the state are one bad accident, lay-off, or catastrophe away from the brink. Regardless of politics, we all share in the responsibility to ensure that when our most vulnerable do hit hard times, they do not go without the basics – housing, food, and medical care.

The NC Budget & Tax Center has released a Brief that lists 5 reasons why a Medicaid work requirement is not a good policy idea in North Carolina. Here’s a quick summary (bonus: the conclusion at the bottom points out what we really need in NC):

 1) Medicaid beneficiaries want to work but can’t find jobs for reasons that work requirements don’t solve.

In North Carolina, nearly 8 in 10 Medicaid adults live in a family with at least one worker. Most people on Medicaid who can work do so, and for people who face major obstacles to employment, work requirements won’t help to overcome them. Such barriers to work include having an illness or disability that prevents them from working (35 percent), lacking child care assistance or are taking care of family (28 percent), participating in school (18 percent).

Furthermore, in 88 of the state’s 100 counties, there are more unemployed workers than there are job openings. This is a major challenge that policymakers must address to enable more jobless adults to access employment opportunities. Medicaid work requirements do not address the job gap.

2) Low wages keep millions of working people across North Carolina in poverty.

Across all 100 counties in NC, there are 2.2 million North Carolinians who have a job but are still earning poverty-level incomes, which is $24,600 for a family of 4. There are 95 counties in which the working poor make up more than 20 percent of the labor force. In 17 of the state’s 100 counties, the working poor population is between 30 and 40 percent. In other words, having a job is good but not enough to get by for many people across the state.

3) Medicaid makes it easier for people to work and search for work.

According to a statewide Medicaid assessment, a majority of enrollees (52 percent) report that Medicaid has made it easier to secure and maintain employment. Among unemployed enrollees looking for work, 75 percent report that Medicaid makes it easier to look for work.

4) A Medicaid work requirement redirects resources away from the goal of reducing poverty.

Spending taxpayer money to cover increasing administrative costs rather than using it to serve the public is not smart public policy. A work requirement for Medicaid beneficiaries would add to health plan administrative costs and shift money away from providing care, according to health insurers that administer benefits for millions of poor Americans. Jeff Myers, president and CEO of Medicaid Health Plans of America, has said work requirements are an administrative burden: “plans would rather spend their time and resources actually caring for their members.

 5) Dedicating resources to work training programs that help people access job opportunities is more effective in the long-term.

To help North Carolinians who are struggling find work and to secure better jobs, investments targeted to skills training programs that result in an industry-recognized credential and providing a strong career pathway program at every community college will increase skills and employment outcomes.

Research shows that public investments in these areas help low-income adults and youth find jobs, improve their earnings and contribute to their communities. For example, one study found that individuals receiving services are more likely to be employed (by about 10 percentage points) than those who have not received services.

 Conclusion

It is clear that instead of cutting funding and making it more difficult for vulnerable parents and children to access health programs in times of need, what we really need in NC is to change how we end poverty  – by providing adequate funding to help North Carolinians create and find work, get access to education and job training, child care, or mental health services to lift them out of poverty.

NC Budget and Tax Center, public health, Trump Administration

GOP health care bill would hurt one million rural North Carolinians who benefit from Medicaid

A new report finds the House-passed health bill – the American Health Care Act – would devastate health care in rural America, primarily because of the dismantling of Medicaid.

This is concerning considering that last year in North Carolina Medicaid offered health coverage to 1.9 million poor seniors, children, parents, and people with disabilities – of which the majority (1 million) lived in the rural parts of the state.

Specifically, North Carolina’s rural counties accounted for the following Medicaid beneficiaries: 60 percent of poor seniors, 53 percent of blind individuals, 58 percent of people with disabilities, 54 percent of pregnant women, and 51 percent of all infants and children. In other words, rural North Carolinians benefit greatly from Medicaid.

According to the report, “Medicaid has long played an even larger role in providing health coverage and paying for care in rural areas than in urban areas. Medicaid’s importance to rural America has only grown under the ACA. Nearly 1.7 million rural Americans have newly gained coverage through the Medicaid expansion.”

Below are key points from the report of why the proposed GOP health care bill would not meet rural needs:

  • Medicaid has expanded access to substance use disorder treatment at a time when many rural communities have been ravaged by the opioid crisis.
  • Medicaid expansion has become a critical financial lifeline sustaining rural hospitals.
  • The bill’s new tax credit for the purchase of individual market coverage would be woefully inadequate for many people in rural areas, and would leave many of the 1.6 million current rural marketplace enrollees unable to afford their high insurance premiums. Unlike the Affordable Care Act’s (ACA) far more generous and flexible tax credit, the House bill’s credit wouldn’t adjust for geographic variation in premiums and would provide too little assistance for older people.
  • In North Carolina, 25 percent of Marketplace Consumers live in rural areas; under the ACA, their average tax credit is $8,411. However, under the proposed bill, their average tax credit would decrease by 66 percent to $2,869. Furthermore, North Carolinians living in rural areas would see the biggest increase – $7,549 – in total out-of-pocket costs under the proposed health bill. Both the net premium ($5,921) and cost-sharing ($1,628) out-of-pocket costs would increase.
  • Rural populations tend to be older and sicker than urban populations. For example, people in rural areas are more likely to die from heart disease, cancer, unintentional injury, chronic lower respiratory disease, and stroke than their urban counterparts. For these reasons, rural residents likely benefited disproportionately from the ACA’s protections against discrimination based on medical history — and they could be disproportionately harmed by removing those protections, as well as by the other major provisions of the House bill.

To learn more see: Medicaid works for women in North Carolina and Medicaid has allowed millions with substance use disorders to get health coverage, access treatment.

NC Budget and Tax Center, public health

On Mother’s Day: Remember Medicaid works for women – but proposed cuts would have a harsh, disproportionate impact

This weekend we celebrate Mother’s Day. Next week we celebrate National Women’s Health Week. The fact is women play an important role in society every day and one thing we can always do for them is support them in having adequate health care. Currently, more than 40 million women and girls are enrolled in Medicaid. However, proposals in Congress to cap and cut Medicaid would have devastating consequences for the nearly 1.1 million women in North Carolina who rely on the program.

This is worrisome considering that Medicaid allows women to obtain the health care they need throughout their lives. According to a recent report, “women have unique health care needs — and nearly half of all women have an ongoing condition requiring regular monitoring, care, or medication.”

By the numbers: North Carolina Women and Medicaid

1.1 million: number of women in NC enrolled in Medicaid

54%: share of women in NC enrolled in Medicaid

898,200: number of women and girls in NC that live below the poverty line

17%: share of women and girls in NC that live below the poverty line (worse than U.S average of 16%)

54%: share of births in NC financed by Medicaid

The race and ethnicity of NC women in Medicaid

White: 44%

African-American: 35%

Hispanic: 14%

Asian/Pacific Islander: 1%

Other: 5%

Overall, women would bear an outsized share of harmful Medicaid cuts because they not only make up a majority (54 percent) of North Carolina’s Medicaid beneficiaries, but are also the primary users of maternity benefits and specific health care services for women. They are much more likely to use Medicaid’s long-term services.

North Carolina hurts when women and girls cannot access the health care that they need to lead healthy, full lives.

Current health bill proposals have disproportionate impact on women

The House-passed health bill also includes several provisions that are especially harmful to women with private insurance.

For example, it would allow states to opt out of the ACA’s Essential Health Benefits (EHB) standard, effectively allowing insurers to charge women more than men by leaving many women without affordable access — or any access — to maternity coverage.

Additionally, it also would give states the option of allowing insurers to charge far higher premiums to people who are pregnant, have had a c-section, or were treated for injuries resulting from domestic violence.

Learn more: To get a better understanding of Medicaid and its impact in North Carolina you can view various graphs in our NC Medicaid Chartbook or read our series, Medicaid Matters: Protect and Expand NC Health Care.

2018 Fiscal Year State Budget, NC Budget and Tax Center

Major differences in NC: Comparing Governor’s and Senate budgets on Health and Human Services

It is clear that the Governor and the Senate have different views when it comes to making health a priority for North Carolinians. Back in March we wrote about the top 5 things you needed to know about the Governor’s recommended budget related to health and human services. This list is presented again below, but this time with the NC Senate budget approach to each of the Governor’s key health related items.

Point #1

Governor Proposal: Medicaid expansion is proposed and would cover over half a million additional individuals in need at minimal cost to the state’s general fund. According to the Governor’s proposed budget, expanding Medicaid eligibility would “cover 624,000 additional individuals and secure our share of federal resources that will inject over $4.4 billion in direct spending into our state.

Senate Proposal: Does not propose Medicaid expansion for the state. In other words, does not expand Medicaid eligibility to cover 624,000 vulnerable North Carolinians.

Point #2

Governor Proposal: Mental Health funding sees the largest increase. The Governor’s proposal in this area represents a 26.9 percent — or $151.6 million — increase over the current 2017 fiscal year budget.

Senate Proposal: Provides $684 million next year to the Division of Mental Health-Developmental Disabilities-Substance Abuse Services. This is $30.2 million less than what the Governor had recommended ($714 million).

Point #3

Governor Proposal: Funding of NC Health Choice, the Children’s Health Insurance Program, would undergo major restructuring. According to the Governor’s budget, “federal matching funds are increasing compared to the base budget and will decrease the need for state appropriations.” As a result, the need for state funding would be reduced by $43 million through the upcoming biennium.

Senate Proposal: Matches the Governor’s recommendation.

Point #4

Governor Proposal: Older adults and people with disabilities will benefit from investments that support independent and community living options. The Governor’s proposal would provide an increase of 13.6 percent – or $6 million – to the Division of Aging and Adult Services. Of the $6 million, $4 million would provide in-home aides, transportation and meals to older, low-income residents in all 100 counties. The remaining $2 million would assist low-income households headed by adults with disabilities to access affordable rental housing.

Senate Proposal: Provides only $1 million to the Division of Aging and Adult Services next year. This is $5 million less than what the Governor recommended. The Senate’s additional funding would be for the “Home and Community Care Block Grant.”

Point #5

Governor Proposal: Almost 40 percent of the proposed increase for Public Health would go to Children’s Developmental Services Agencies (CDSA). The Governor’s proposal would increase the Division of Public Health’s budget by $6.8 million.

Senate Proposal: 14 percent of the proposed Senate increase for Public Health would go to Children’s Developmental Services Agencies. Only provides an increase of $4.5 million next year to the Division of Public Health. In other words, falls $2.3 Million short compared to what the Governor proposed for this division. Over the full biennium, the Senate only provides $7.5 million while the Governor had called for $17.7 million.

2018 Fiscal Year State Budget, NC Budget and Tax Center

NC Senate budget fails low-income housing, military and veterans; eliminates public sector jobs

[Note: The following analysis pertains to North Carolina’s general government agencies. Every state across the country has general government agencies that provide core public services and functions for citizens and government. In North Carolina, these agencies consist of: Administration, Auditor, General Assembly, Governor, Housing Finance Agency, Insurance, Lieutenant Governor, Military and Veterans Affairs, Office of Administrative Hearings, Revenue, Secretary of State, State Board of Elections, State Budget and Management, State Controller, Treasurer.]

The Senate’s budget provides for development of low-income housing units but falls $4 million short compared to Governor’s request

The Senate’s proposed budget provides $16 million next year in non-recurring money to the Workforce Housing Loan Program (WHLP). In contrast, the governor recommended $20 million in funding for the WHLP to assist with the development of low-income housing units across the state. According to the Senate’s budget, the funds for this program were received by the state from a settlement agreement with Moody’s Corporation.

The Senate’s budget fails the NC Department of Military and Veteran’s Affairs

The Senate’s budget also falls $1.7 million short of what the Governor recently recommended for the Department of Military and Veterans Affairs. This is unfortunate given that one of North Carolina’s goals is “to be the most military friendly state in the country,” and that our state is home to nearly 800,000 veterans, 145,000 military defense personnel, and several major military installations.

The Governor proposed providing the Department an additional $3.9 million over the next biennium. However, the Senate’s budget would only provide the Department $2.2 million of what the Gov. requested. As one example, while the Gov. requested $4 million to support efforts to retain and enhance North Carolina military bases through the Base Realignment and Closure (BRAC) process, the Senate only provides $2M to the Military Presence Stabilization Fund (which assists communities in investment efforts to sustain and maintain the state’s military programs and activities).

To make matters worse, Read more