NC Budget and Tax Center, public health

Virginia votes to expand Medicaid for some. We can do better.

Last week, North Carolina’s northern neighbor, Virginia, voted to expand Medicaid coverage to 400,000 low-income residents, making it the 34th state to do so since the passage of the Affordable Care Act in 2010. If North Carolina wants to compete with our southern neighbors, as we so often hear in policy debates, now is the time for policymakers to move ahead with closing our state’s coverage gap.

They should do so for everyone, demonstrating their leadership by passing a more comprehensive coverage plan that doesn’t include red tape or exclusions.

Virginia’s state legislature voted to extend coverage to many uninsured Virginians. However, the inclusion of requirements that those eligible work a minimum number of hours each month will limit coverage for an estimated 50,000 individuals who would otherwise be eligible for coverage. It is a move that doesn’t acknowledge current labor market realities and is likely to cost the state more to implement. So-called “work requirements” create significant administrative burden for states, and will cost Virginia approximately $1.2 million in the next two years alone.

Furthermore, work requirements do not address the root causes of poverty, and they generally exacerbate the problem. Data show that almost all adult Medicaid recipients who do not work either have a disability, serve as a caretaker to family, attend school, are retired, or could not find work. These requirements hurt most enrollees, including the most vulnerable, such as children, adults with disabilities and those with substance use disorders, as enrollees wrestle with complex administrative requirements for reporting and documenting their work hours each month.

Let Virginia’s restricted expansion of health coverage be a signal for North Carolina lawmakers to enact better, evidence-based legislation that demonstrates their commitment to promote the health and well-being of all in our state.

Suzy Khachaturyan is an MSW/MPH intern with the Budget & Tax Center, a project of the North Carolina Justice Center. 

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 with the N.C. Budget and Tax Center