NC Budget and Tax Center

Federal court strikes down Medicaid work requirements — this time in New Hampshire

On Monday, a federal judge overturned approval given by the U.S. Secretary of Health and Human Services that would have allowed New Hampshire to impose work-reporting requirements on Medicaid recipients. Such requirements are at odds with the objective of Medicaid to provide medical assistance, the judge stated, citing the experience in Arkansas where more than 16,000 individuals lost their Medicaid coverage.

“In short, we have all seen this movie before,” U.S. District Judge Boasberg stated in his decision. The same judge struck down similar waivers in Arkansas and Kentucky earlier this year.

Proponents of work-reporting requirements claim that they improve enrollee health and incentivize community engagement. However, the reality is that many low-income adults who need health coverage in order to enter the workforce lose coverage as a result of the requirements, thereby making it harder to manage their health needs.

Adults who meet exemption criteria are unaware that they do, or are unable to jump over the hurdles necessary to prove that they are exempt. Others don’t meet the narrow criteria for disability that would grant them an exemption. A recent study (summarized here) from Arkansas found that many of the individuals who lose coverage are actually meeting the requirements but are unable to report their hours for various reasons.

Our findings estimate that 88,000 North Carolinians could lose coverage due to work reporting requirements.

In addition to the harm they impose on Medicaid recipients, work reporting requirements are costly and complicated to administer. Modifying current systems to determine eligibility and exemption, creating and implementing ways for recipients to report work hours, and disseminating information about the new requirements as a condition of Medicaid coverage are just a few of the costly steps to administer and that require hiring additional staff.

The legal precedent supported by this latest federal court ruling should discourage states from following a similar path to Medicaid expansion with a waiver, given that they’ve been deemed illegal in three states so far. Instead, states should seek to increase access to Medicaid coverage through “clean” expansion and not by erecting barriers that create harm and unnecessary cost.

Suzy Khachaturyan is a Policy Analyst at the Budget and Tax Center, a project of the North Carolina Justice Center.

NC Budget and Tax Center

Trump administration rejects Utah’s bid for more federal funds for “partial” Medicaid expansion

Late last week, White House officials stated that they would not approve enhanced federal funding for Utah’s partial Medicaid expansion, according to news reports, raising questions about the viability of the plan given the significant cost to the state.

This follows an earlier decision from the Centers for Medicare and Medicaid Services (CMS) that gave approval for Utah’s waiver request to expand Medicaid only up to 100 percent of the Federal Poverty Level (FPL). Medicaid expansion under the Affordable Care Act permits states to expand up to 138 percent FPL in exchange for the federal government paying 90 percent of the cost of services for those who gain new coverage, up from the current 68 percent match rate in Utah.

It turns out that Medicaid expansion up to the 138 percent level is not only best able to maximize the health and economic benefits to states, it also is the most (and only) fiscally responsible option for state policymakers.

Utah is the first state to submit a waiver for partial expansion without already having expanded Medicaid and, given the absence of additional federal funds to do so, it would seem fiscally unwise that a state would take up this option moving forward.

Wisconsin is the only state to extend coverage up to 100 percent FPL, absent Medicaid expansion, and does not receive the enhanced federal match. In fact, Utah’s funding rejection follows in the footsteps of other states, who both sought to lower their income eligibility requirements for Medicaid.

Partial Medicaid expansion is one of several mechanisms by which states have tried to restrict eligibility and coverage while expecting the federal government to provide additional financial support.

It not only compromises the integrity of Affordable Care Act, which created the option for states to expand Medicaid in the first place, but blocks the possibilities for greater health from being realized through state action.

Suzy Khachaturyan is a Policy Analyst at the Budget and Tax Center, a project of the North Carolina Justice Center.

NC Budget and Tax Center

Conference budget is a disappointment for North Carolina

The conference budget passed this past week by both legislative chambers misses a whole host of opportunities to provide adequate, basic services and improve the lives of everyday North Carolinians. Legislative leaders describe this budget as a compromise that maximizes the use of limited dollars, yet those very legislators have prioritized tax cuts over investments in the services and programs that strengthen our growing state.

The false choices represented in this budget — innovations waivers versus closing the coverage gap, teachers versus early childhood programming — are largely the result of these tax cuts for the wealthy, which began in 2013. With $3.6 billion in lost revenue each year since then, General Assembly leaders have proposed additional cuts for the richest North Carolinians that worsen the already upside-down tax code that places a greater tax burden on those with the lowest incomes.

Here are just a few of the ways that the conference budget fails to make proper investments in our state:

With Friday’s veto from the Governor, we will look to legislators on both sides of the aisle for a sustained veto so that our elected leaders can start over on a new budget that reaffirms our collective values and better addresses the needs of all in our state.

Suzy Khachaturyan is a Policy Analyst at the Budget and Tax Center, a project of the North Carolina Justice Center.

NC Budget and Tax Center

Report: Most U.S. citizens would likely fail Trump administration’s “public charge” proposal for immigrants

A new report released by the Center on Budget and Policy Priorities describes the widespread harm that would be caused if the proposed rule released last year by the Department of Homeland Security (DHS) — that would substantially change the way some immigrants are assessed as a public charge — if it becomes a final rule. Specifically, the rule would negatively affect many immigrants’ ability to apply for admission to the United States or for current lawful immigrants to seek an extension of stay or change of status.

To illustrate the widespread harm the rule would impose, the report details the number of U.S. citizens that might be deemed a public charge if the rule applied to them, using data that captures public benefits use by U.S.-born citizens over a 19-year period. Researchers approximate that more than half of the U.S.-born population participates in a benefit program over the course of their lifetime that may result in them being deemed a public charge, if the proposed rule was applied to U.S.-born citizens.

In addition to observing the use of public benefits in public charge determinations, the proposed rule introduces an income test among other additional criteria for making an admissibility determination. If implemented, immigration officials would be asked to make a prediction as to whether an immigrant below 125 percent of the federal poverty level may, at some point in the future, use one or more public benefits, or otherwise become dependent on the government for support. This broadening would subject immigrants to the biases of immigration officials and, as the report describes, would have a racially disparate impact on the immigrants allowed in the United States. Read more

NC Budget and Tax Center

Ten slides that explain the differences in the House and Senate budget proposals

The budget is ultimately about priorities and the choices that our elected leaders make about where tax dollars will go. Legislative leaders have already severely restricted the range of choices available artificially by continuing to cut taxes for the wealthy and big companies. When the latest round of tax cuts are in full effect, the state will have an annual loss of nearly $3.6 billion. And the two current budget proposals include additional tax cuts that will result in fewer dollars for the public good than would have otherwise been available.

As the conference budget process continues through the weekend, here are some select items that are important to the well-being of North Carolinians and our communities.

Once the conference report is released, we will analyze how the conference budget decides between these two proposals.

Suzy Khachaturyan is a Policy Analyst at the Budget and Tax Center, a project of the North Carolina Justice Center.