Monday numbers: A closer look at the destructive impact of work requirements and premiums for Medicaid recipients

Monday numbers: A closer look at the destructive impact of work requirements and premiums for Medicaid recipients

Despite years of obstruction by Republican leaders in the General Assembly, North Carolina seems to be inching, ever so slowly, in the direction of expanding eligibility for Medicaid health insurance under the terms of the Affordable Care Act. Gov. Cooper has made expansion a key component of his proposed state budget and a top policy priority for his administration – a move that has attracted a measure of support from groups of GOP lawmakers.

Unfortunately, even as the prospect of Medicaid expansion grows more and more politically feasible, some lawmakers are touting the idea of requiring newly-eligible low-income people to pay premiums and/or meet work requirements in order to enroll in the program. Indeed, a new Senate proposal seeks to impose a work requirement on a sizable chunk of existing Medicaid recipients.

As the following numbers make clear, both of these ideas would be counter-productive and assure that large numbers of people in need would continue be excluded from coverage or lose their current eligibility.

2.1 million (including 1.2 million children) – number of North Carolinians currently enrolled in the state Medicaid program (“NC lawmakers push Medicaid work requirements as patients, advocates and courts push back,” NC Policy Watch, 4/4/2019)

0 – percentage of “able bodied” North Carolina adults without children who are eligible (N.C. Institute of Medicine Issue Brief, 4/2017)

387 – North Carolina Senate Bill that would impose new 80 hour per month work requirement on many existing Medicaid recipients

0 – number of states that currently impose a work requirement on their traditional Medicaid populations (ibid.)

60 – estimated percentage of Medicaid recipients nationally who already work (“Understanding the Intersection of Medicaid and Work,” Kaiser Family Foundation, January 2018)

More than 80 – percentage of those not working who are students or unable to work due to a disability, serious illness, or caregiving responsibilities (“Arkansas’s Failed Experiment: Work Reporting Requirements in Medicaid,” NC Justice Center, 3/28/2019)

80 – number of hours per month that the state of Arkansas began requiring Medicaid expansion enrollees to work in July of 2018 (ibid.)

25 – percentage of enrollees who lost Medicaid coverage as a result of the new reporting requirement (ibid.)

4 out of 5 – of the 25%, the share who lost coverage because of bureaucratic reporting problems rather than actual failure to meet the work requirement (ibid.)

Less than 2 – percentage of Arkansans in the program whose reported work was actually under the 80 hour requirement (ibid.)

12 – number of days since a federal judge struck down Medicaid work requirements implemented in Arkansas and proposed in Kentucky, emphasizing in the opinion the role of Medicaid in providing medical assistance to people with low income in our country (ibid.)

500,000 – estimated number of people who could benefit if North Carolina follows the lead of 37 other states and expands Medicaid under the terms of the Affordable Care Act (“Could you qualify if Medicaid were expanded in NC? And will private management change it?” News & Observer, 2/6/2019)

2 – percentage of their household income that 2017 “Carolina Cares” Medicaid expansion proposal would have required most new enrollees to pay as a premium in order to gain eligibility (“Health care or food on the table? North Carolinians Face Impossible Choices if Medicaid Expansion Requires Premiums,” NC Justice Center, March 2019)

43 – Under North Carolina’s current eligibility rules, parents must have incomes below roughly 43 percent of the federal poverty level (FPL) to be eligible for Medicaid (ibid.)

$589 – annual cost that such a premium requirement would impose on a single parent with two children with an annual income of $29,440 (138% of the Federal Poverty Level) (ibid.)

$768 – annual cost that such a premium requirement would impose on married couple with a combined annual income of $15,220 (90% of the Federal Poverty Level) (ibid.)

62 – percentage of Medicaid expansion enrollees in Michigan (which enacted a similar 2% premium requirement after six months in the program) who missed premium payments (ibid.)

55 – percentage of Medicaid expansion enrollees in Indiana (which required monthly contributions to enrollee accounts modeled after health savings accounts) who failed to make their payments (ibid.)

Negative $2,339 – median annual income of average American low income households after accounting for expenditures (ibid.)

$52,946 – amount of annual income that the average family of four in North Carolina needs to in order to afford basic expenses (ibid.)

100 – percentage chance that either a work or premium requirement would result in thousands of struggling North Carolina families being denied eligibility for Medicaid  (See above)