NC Budget and Tax Center

Evidence from Arkansas: Medicaid work requirements don’t work

Last week, Governor Cooper vetoed the General Assembly’s conference budget, pointing to harmful corporate tax cuts, a failure to fully fund the needs of teachers and their classrooms, and a failure to include Medicaid Expansion. Both the Governor and Secretary of Health and Human Services Mandy Cohen have noted that any Medicaid Expansion bill will likely include compromises.

It is highly likely that requirements to report work are being considered as a form of a compromise, but evidence shows that these requirements fundamentally undermine the expressed purpose of Medicaid itself and will result in struggling North Carolinians jumping through hoops to prove that they are working as a condition of receiving medical coverage. A recent report in the New England Journal of Medicine evaluates the impacts of Arkansas’s work requirement provisions. The report finds that:

Work reporting requirements prevented people from accessing health care while doing nothing to boost employment:

  • From 2016 to 2018, the percentage of 30-49-year-olds with ACA marketplace coverage dropped from 70.5 percent to 63.7 percent, much more than groups not subject to work requirements.
  • The percentage of uninsured adults ages 30 to 49 increased from 10.5 percent to 15 percent while other groups remained unchanged – in control states, the uninsured rates were unchanged for this same population.
  • From 2017 to 2018, employment among groups subject to work requirements declined from 42.4 percent to 38.9 percent.

Due to massive amounts of red tape and administrative burdens, many working Arkansans were unjustly denied health insurance:

  • 97 percent of people subject to the requirements were already meeting the work and community engagement requirements prior to the policy taking effect.
  • 9 percent of people subject had not heard anything about the policy change.
  • More than 44 percent of people were unsure about whether the requirements applied to them.
  • 100 percent of people who failed to report because they thought they had not satisfied the requirements had, in fact, satisfied the requirements.

You can read the entire report HERE.

Brian Kennedy II is a Public Policy Analyst for the Budget & Tax Center at the N.C. Justice Center.

NC Budget and Tax Center

Senate bill will take food assistance away from families while costing N.C. millions

Today, the North Carolina Senate will vote on a bill aimed at punishing parents who struggle to keep up with child support payments by taking away their food assistance. Senate Bill 551, the Child Support Cooperation Act, is based off of myths and stereotypes rather than an actual understanding of what families with low-incomes actually need.

Here are some realities about the negative impacts of child support enforcement in SNAP:

  1. Taking away food from struggling parents will not result in increased payments.

Under this policy, North Carolina can choose to punish custodial parents who choose not to open a child support case or modify or enforce an existing support order, in addition to parents not keeping up with payments. Child support enforcement for SNAP families is already fairly strong. In fact, over the past 20 years, the amount of financial support paid by parents has increased by 22 percent.  Additionally, the program already provides incentives for parents who do cooperate.

  1. This policy risks increasing food insecurity among survivors of abuse and the children they care for.

The reality is that many non-custodial parents are providing informal support. Parents who earn low wages and have inconsistent schedules may pay when they are able. Other parents may support their children in other ways by co-parenting or buying supplies. Parents who choose not to participate in the child support system often do so for good reason. For example, a study from Texas found that more than 4 in 10 mothers who did not receive any type of child support were survivors of abuse.

Senate Bill 551 doesn’t acknowledge that people’s lives, circumstances, and needs are complex. Instead, this blanket policy threatens to remove food from people already struggling to make ends meet who are caring for children.

  1. This policy is costly and complex to administer.

Similar to other policies that seek to limit who can access federally funded social support programs, Senate Bill 551 will cost the state money to administer and will result in zero savings. A study done in 2017 estimated implementing this policy would cost North Carolina more than $5.6 million. In addition to the costs, attempting to enforce this would add additional paperwork and red tape for families seeking food assistance as well as the DSS offices and case workers charges with helping them.

Just last year, North Carolina ran a similar pilot program requiring families receiving child-care subsidies to participate in the child support enforcement program. The study found that only 90 percent of families were not already participating or exempt. In the end, forcing families to participate resulted in $7,000 in increased child support payments in 12 families while costing the state $2 million to implement.

There are better ways to support struggling families.

This is not the first time a bill like this has been seen. In fact, a 2014 study found that out of 10 states that had adopted this very same policy, seven states had rescinded because they discovered it was costly, burdensome, and did not help families.

There are ways to encourage cooperation in the child support enforcement system that do not put people at risk of food insecurity. Rather than taking away food support, lawmakers should seek to understand the needs of struggling families and remove the real and primary barriers to putting food on the table.

Brian Kennedy II is a Public Policy Analyst for the Budget & Tax Center at the N.C. Justice Center.

NC Budget and Tax Center

In Medicaid, work requirement will punish those who need help the most

House Bill 655, the “NC Health Care for Working Families” is intended to close the coverage gap and provide health insurance to North Carolinians who previously did not have access. Unfortunately, this bill contains troubling provisions that will harm the very people legislators claim to help. Specifically, the work reporting requirements are an ill-informed and bad faith effort to increase employment. Not only do these provisions fly in the face of the vast amount of evidence which proves they do not work, they are based off of nasty stereotypes and are not reflective of the lives of people struggling to make ends meet. In fact, these requirements restrict access to public supports for the people who need help the most and who rely on those supports to work and lead full lives.

The work reporting requirements in House Bill 655 are identical to those in the nation’s food nutrition program (Supplemental Nutritional Assistance Program or SNAP). Talk Poverty, an editorial project of the Center for American Progress, documents a first person account of just how inflexible and punitive these policies actually are:

My fibromyalgia doesn’t care about my work schedule. It doesn’t time its flare-ups according to my current proximity to heating pads. Even more than Beamer, my service dog, fibromyalgia is the most constant presence in my life, on my mind at all hours of the day. In the morning, my joints could be so sore that I forgo my cup of coffee, because I can’t trust my grip and I don’t want to clean up another shattered mug. By the afternoon, those aches may give way to a fog that clouds my mind until any attempt at sustained concentration feels like running up a downward escalator — a lot of effort, but little payoff.

People with disabilities are supposed to be spared from the cuts. But in practice, many people with serious health conditions will be at risk of losing food assistance, because SNAP uses other government programs with an extremely limited definition of disability as proxies for disability status. So, I’m on the chopping block.

If I need to miss a shift because I woke up feeling particularly sore or because the afternoon fog rolled in early, the benefits I rely on to eat are threatened. Good day or bad, doctor’s appointment or not, I have to make sure I’m on time and ready, smiling at the customer service desk of the museum that is my work place.

Read the full story here.

Commentary, Legislature, NC Budget and Tax Center

GOP Medicaid bill takes a massive step in the wrong direction

Rep. Donny Lambeth, R-Forsyth, presenting the GOP’s Medicaid bill Tuesday.

Yesterday, legislators filed a new version of Medicaid expansion, House Bill 655, titled “NC Health Care for Working Families.” This bill imposes even harsher work compliance provisions on low-income and poor North Carolinians than previous versions.

Specifically, the bill follows the work reporting requirements seen in the Supplemental Nutritional Assistance Program (SNAP, formally known as food stamps). This raises a serious concern, considering that extensive research has demonstrated just how broken the SNAP program’s work provisions are.

A new report from the nonprofit ideas42 points out that not only do work requirements not help people to find jobs, the provisions seen in the SNAP program have the exact opposite effect. The report finds that:

  • The burdensome compliance of requirements dramatically increases the cost of obtaining assistance. Under SNAP rules, people are required to prove that they worked 20 hours a week. Lost paperwork, missed notices, and clerical errors have resulted in a significant number of people losing benefits, despite the fact that they’ve actually fulfilled the requirements. Additionally, many low-wage workers lack access to predictable schedules, paid leave, and other basic protections. This means that, regardless of a worker’s best efforts to comply, they may easily fall short due to circumstances completely out of their control.
  • Rigid work requirements fail to recognize that people living in poverty know best how to prioritize their time. People living in poverty face tremendous everyday pressures of deciding how to best use their time in order to fulfill their obligations and to make ends meet. The rigid 20-hour work requirement does not reflect the reality that a disproportionate number of low-wage workers are employed in seasonal industries with unpredictable hours, or that they are more likely to take time to care for sick or aging family members. Rather than attempting to legislate the schedules of North Carolinians living in poverty, policy makers should provide them with the tools to make decisions and choices to help lift them out of poverty.
  • These policies rely on and reinforce harmful and misguided beliefs about people living in poverty. Proponents of work requirements believe that these provisions will force people uninterested in work to find jobs. This presumption that this belief is built on could not be further from the truth. The U.S. Census Bureau found that less than 0.3 percent of SNAP recipients aged 18-49 reported that they are not working because they are not interested. Behavioral research has found that people living in poverty actually make better and more rational choices in regards to money than people with high incomes. This is because they have to. When living in poverty, there is very little wiggle room for wasteful or poor choices.

Rep. Donny Lambeth, R-Forsyth, states that the work requirements are a political necessity, arguing: “There are things we as legislators have to do in order to get things done.” This thought, however, does not reflect the emerging national conversation on work reporting requirements in our safety net programs.

Last year, proposals in Congress to make SNAP’s work requirements even more restrictive met opposition from both Republicans and Democrats. In a show of bipartisanship, legislators decided that more work requirements were not a good idea, and that making sure that struggling people receive the help they need was a higher priority.

Just last month, a federal judge ruled that similar Medicaid work requirements in Arkansas and Kentucky were illegal and that they undercut the entire objective of the Medicaid program to provide “medical coverage to the needy.” Research shows that when people have access to critical supports like food and healthcare, they are more likely to find gainful and steady employment.

Work requirements are an ill-informed attempt to legislate behavior and do not reflect the realities of people living in poverty. In fact, the science shows that they effectively take away the ability of people to make good, rational decisions. If our legislators are truly in the business of helping to improve the lives of North Carolinians, they will listen to the research and evidence and reject these harmful provisions.

Brian Kennedy II is a Public Policy Analyst for the Budget & Tax Center at the N.C. Justice Center.

NC Budget and Tax Center

Federal court decision on Medicaid waivers at odds with N.C. General Assembly

Last week, a federal judge in Washington, D.C., blocked Medicaid waivers submitted by Kentucky and Arkansas, ruling that the waivers were “arbitrary and capricious” and that they undercut the objective of the Medicaid program: providing “medical coverage to the needy.” The waivers, which had been approved by the Trump Administration, allowed the states to place harsh work reporting requirements as conditions for low-income workers to receive health care.

Since Arkansas implemented the harsh requirements last year, as many as 18,000 people have lost health coverage, largely for failing to meet the reporting requirements. Also, state officials have failed to prove that their provisions are having the intended effect of helping people to find work. This should come as no surprise. Research from the Center on Budget and Policy Priorities finds that coverage increases the likelihood that an unemployed worker will be able to find and keep employment. When people have access to treatment for chronic illness, it increases their ability to hold a steady job.

North Carolina is no stranger to conversations around restrictions to Medicaid for low-income families and workers. Introduced just last week, Senate Bill 387 proposes to place work reporting requirements on low-income parents with young children who currently receive Medicaid. The bill would require NC DHHS to submit a waiver request to the federal government by Oct. 1, containing the work requirements just deemed illegal by the court.

This change in policy, if allowed to go forward, would not only be expensive to enforce and difficult to navigate, it will legitimately threaten the well-being of not just parents, but the children who rely on them.

In addition to imposing work-reporting requirements on existing Medicaid participants, legislators have in the past suggested that these barriers be included as part of  any Medicaid expansion under the Affordable Care Act, thus creating greater administrative costs and reducing the effective closure of the coverage gap in our state.

In general, work-reporting requirements ignore the fact that a significant number of Medicaid recipients who can work are already working. According to the Working Poor Families Project, three out of every four low-income families in North Carolina have at least one family member who works. But another study finds that even among those working at least 1,000 hours a year, one in four would be at risk of failing to meet work requirements due to unpredictable work scheduling and temporary work.

What does this court decision mean for North Carolina? Read more