Commentary, NC Budget and Tax Center

Legislature considering changes to Medicaid that would pose a huge danger to mothers and infants

Early next week the North Carolina General Assembly is expected to release a budget that may include taking health coverage away from people who do not meet work requirements. Faced with unrealistic work hour quotas, these proposals will mean that many adults, such as new moms, will lose essential health coverage. Loss of coverage, and the decline in health that will result, will make employment and employment prospects more difficult and will push women and their families further into poverty. While it remains to be seen if CMS would approve such a harsh proposal, its potential impact would be felt throughout North Carolina.

These requirements would likely require new mothers to return to work 60 days after birth, at which time pregnancy Medicaid expires. In reality, many mothers do end up working; data show that 62% of parents on Medicaid work. Rushing new moms into the workforce is bad for infant health, and poor maternal-infant bonding is known to have lasting effects. Research shows that mothers’ early return to work has negative impacts on the duration of breastfeeding, infant vaccinations, and regular checkups, and may diminish maternal-infant bonding as a result of less time spent together and increased maternal stress. Studies show that children are more likely to receive the care they need if their parents have insurance coverage, suggesting that the health of low-income infants and children would decline as a result of work requirements for parents.

A rigid work requirement for moms and parents with low-income fails to account for the cost and difficulty of finding child care and job market realities.

And in the case of North Carolina, such a policy would create a cliff for many families where increasing work hours and income will push them into the coverage gap. For example, a single mother with two children who works 23 hours per week at minimum wage, earning only $667 per month, would be ineligible for Medicaid because their income is too high. With high-quality child care costing a median $832 per month per infant in our state in 2017, North Carolina mothers and families are already forced to make tough decisions about returning to work.

To protect maternal and child health in North Carolina, policymakers should be closing the coverage gap not pushing more people into it without the prospect of accessing the tools to live healthy and financially secure lives.

Suzy Khachaturyan is a MSW/MPH Intern, Budget and Tax Center

Commentary

Legislators should reject efforts to extend failed virtual charter school “pilot”

The General Assembly should reject any efforts to extend the authorization of the state’s two virtual charter schools, and should instead focus on winding down the two failing schools.

Since their creation, North Carolina’s two virtual charter schools, North Carolina Virtual Academy and North Carolina Connections Academy, have been among the worst-performing schools in the state. Advocates for these two schools have opposed meaningful accountability or evaluation measures, rushing forward to extend without any evidence that the program is working. The schools are based on a model that has failed spectacularly in several other states, and North Carolina’s laws offer no protections against the failures of other virtual charter schools. Finally, the schools fail to meaningfully expand enrollment options for students, as the state already offers a higher-quality on-line option.

Why is the General Assembly considering an extension?

Virtual charter schools are publicly-funded schools that are governed by an independent board and deliver instruction entirely on-line. The North Carolina General Assembly authorized two such schools to operate beginning the 2015-16 school year. The authorizing language (Section 8.35 of S.L. 2014-100) established the schools as a four-year “pilot program,” requiring additional legislation for the schools to continue operation beyond the 2018-19 school year.

At its May 1, 2018 meeting, the Joint Legislative Education Oversight Committee endorsed draft legislation to allow the two virtual charter schools to continue operating through the 2022-23 school year. The legislation, since introduced as HB 988/SB 731, also delays by two years the first of two required evaluation reports, pushing the reporting date from November 15, 2018 to November 15, 2020.

NC virtual charter laws eschew best practices, reflecting the aggressive lobbying efforts of for-profit corporations

Virtual charter schools came to North Carolina largely via the aggressive lobbying efforts of for-profit operators, particularly K12 Inc. Their efforts led to the authorization of virtual charter schools via a four-year “pilot” program – inserted into the 2014 budget bill to avoid debate and scrutiny.

Prior to the introduction of the authorizing language, the State Board of Education had conducted a study to develop a set of policy recommendations for how best to authorize virtual charter schools in North Carolina. These recommendations were ignored by the General Assembly in favor of language crafted by virtual charter lobbyists. The legislature eschewed the State Board’s recommendations on appropriate funding levels, grade levels served, teacher-student ratios, and allowable dropout rates.

Since authorization, the Fiscal Research Division supplied members of the General Assembly and the State Board of Education with policy options to address 16 weaknesses with the authorizing language included in the 2014 budget bill. The General Assembly has failed to address any of these identified policy weaknesses. The only change to the language so far has been a move to weaken oversight of these schools’ dropout rates, allowing more students to withdraw from virtual charters mid-year without facing state sanctions.

North Carolina’s virtual charter schools are arguably the worst-performing in the state, consistent with national research

North Carolina’s virtual charter schools have performed exceptionally poorly. In their first year of operation, both virtual charter schools ranked dead last in the state for student growth. The following year proved little better. Once again, North Carolina Connections Academy finished dead last in the state for student growth. North Carolina Virtual Academy raised itself off the absolute bottom, but still finished in the bottom one percent of schools on student growth, getting outscored by 2,443 of 2,464 schools with a student growth score. Read more

Commentary

NC Policy Watch Policy Prescription #9: Expanding opportunities for justice within the criminal justice system

As the 2018 legislative session gets underway in earnest in this, its first full week, we hope you will continue reading our special series “Policy Prescriptions” researched and written by A. J. Fletcher Foundation Fellow Samone Oates-Bullock. Last week, Prescription #1 addressed food insecurity in North Carolina. Prescription #2 took on the issue of early childhood investments. Prescription #3 analyzed the challenge of funding school adequately and fairly. Policy Prescription #4 called for racial equity in education. Policy Prescription #5 called for tackling the issue of environmental racism in North Carolina. Prescription #6 made the case closing the Medicaid coverage gap. Prescription #7 urged lawmakers to make North Carolina more worker-friendly. Yesterday, Prescription #8 called for new and transformative investments in affordable housing.

Today, the focus is on tackling the issue of second chances for those who have run afoul of the criminal justice system. The following is from Policy Prescription #9 – “Creating second chances: Expanding opportunities for justice within the criminal justice system”:

“While the U.S. crime rate has dropped steadily since its peak in the 1990’s, incarceration rates have continued to rise at an alarming pace. For this reason, the United States now accounts for almost a quarter of the world’s prison population while representing less than five percent of the total world population. The inconsistencies between crime and punishment highlight only one piece of the puzzle. In addition to incarcerating more people than any other country in the world, today’s justice system disproportionately targets and incarcerates African Americans. As of 2018, the U.S. population is 12.6 percent African American and 73.3 percent white; whereas the prison population is 37.9 percent African American and 58.4 percent white . This trend of widespread and disproportionate imprisonment has had detrimental impacts on our economy, communities, and the quality of life for people with criminal records. The fight for second chances is undoubtedly complex, but recognizes the need for a justice system that places rehabilitation, reentry, and morality at the forefront of its operations.”

Click here to read the entire report.

Commentary

Latest state legislative Medicaid proposal may be too harsh to get approved by Trump administration

The public just learned that lawmakers are rushing to consider adding new rules to North Carolina Medicaid that would make people uninsured if they cannot prove they’re working a minimum number of hours each month. This proposal to add red tape and bureaucracy is bad policy, plain and simple. But there are other reasons that even conservative lawmakers should reject it.

First and foremost, signals coming from the Centers for Medicare & Medicaid Services (CMS)—which would have to approve the proposal—suggest that they are not ready to greenlight so-called “work requirements” in states like North Carolina that have not expanded Medicaid. In practical terms, this could lead to longer delays in decision-making by the federal government.

While expansion states like Kentucky, Arkansas, and Indiana have been authorized to implement  these requirements—which are still bad policy—CMS Administrator Seema Verma has expressed skepticism about what happens if they approve similar requirements in non-expansion states:

Because there is no tax credit for them to move on to the exchanges, what happens to those individuals?  We need to figure out a pathway, a bridge to self-sufficiency.

CMS Administrator Seema Verma

After all, Medicaid eligibility in our state is so restrictive that a single parent household with one child has to make less than $6,828 annually to qualify. Since the state hasn’t expanded Medicaid, these new requirements may make it impossible to keep your health coverage: if you can’t prove you’re working, you lose eligibility, but if you do work—even a part-time minimum-wage job (which, by the way, won’t offer health insurance)—you’ll make too much to qualify for Medicaid and too little to qualify for subsidies under the Affordable Care Act.

Adding these new administrative complexities behind closed doors during budget talks will not leave adequate time to understand their implications. For conservative lawmakers who have invested so much time and energy into moving our Medicaid program from fee-for-service to a managed care system, it’s likely that adding these new requirements—which will cost millions of taxpayer dollars to administer—will add even further complexity to our managed care transition.

Whether it’s due to being denied approval or put on hold by the Trump administration, or due to all the new systems that will have to be designed to determine eligibility, implement and enforce the requirements, create systems for enrollees to report their hours and occupations, and so on, it’s very likely that this will delay our Medicaid system change even further.

Commentary

Editorial lauds proposed “red flag” gun law

Rep. Marcia Morey

Raleigh’s News & Observer published an excellent editorial this morning that ought to be a “must read” at the Legislative Building. As is pointed out in “NC needs a red-flag law to stem gun violence caused by mental distress,” every time there’s a mass shooting, the NRA and its apologists claim the problem isn’t guns but the people who use them. Now, a smart state legislator and former judge has proposed legislation that responds to that claim by proposing a bill that would allow a judge to issue an order confiscating the guns — at least temporarily — of someone who is found to be a danger to themselves or the community. Here’s the N&O:

“Red-flag laws enable family members or law enforcement to ask a judge to issue a temporary order for the removal of guns from a person who is a danger to himself or others. The measure is similar to restraining orders in domestic violence situations.

If anyone in the legislature knows about the need to allow judges to intervene in volatile situations, it’s Morey. During 18 years as a judge on the Durham district court bench, she presided over many hearings in which such a protective order might have helped prevent a shooting or a suicide….

The bill, Morey said, would allow the courts ‘to remove guns from the hands of people who are on the verge of violence to others or themselves.’

While prompted by recent school shootings, Morey’s bill would also help stem a far more common form of gun violence, suicide. Rep. Grier Martin, D-Wake, and member of the Army Reserves, spoke briefly in support of the proposal as a way to reduce the high level of suicide among veterans.

‘If you ask the experts that actually do the research on this what some of the factors are that go into the increasing number of suicides, one of them is, in fact, access to lethal means,’ Martin said.

Gun rights advocates are wary that red-flag laws could lead to even broader government power to confiscate guns. But no right is absolute, especially when it presents a deadly threat to others. Morey’s bill includes judicial procedures that protect an individual’s constitutional rights even as its prevents the mentally disturbed from harming others or themselves.

Moore should bring this bill forward. Better yet, he should add his name as a co-sponsor. In doing so, the House Speaker wouldn’t be just rescuing a bill from knee-jerk rejection. He could well be rescuing lives.”

Click here to read the entire editorial.