Last week, state senators of both parties advanced a bill  out of the Senate Health Care Committee that would allow parents on Medicaid, who temporarily lose custody of their kids, to keep their coverage so they can more easily get drug or mental health treatment.
This makes obvious sense for numerous reasons.
As NC Policy Watch journalist Lynn Bonner reported :
Sen. Danny Britt, a Lumberton Republican and one of the bill’s primary sponsors, said staying on Medicaid would make it easier for parents to obtain court-ordered substance abuse or mental health treatment while their children are in foster care. Losing Medicaid causes months-long delays while parents search for other ways to pay for treatment, he said.
‘We all know the statutory goal is reunification,’ he said.”
Good for Britt and the other members of the committee. Anything our state can do to help struggling families trying stay together is a welcome move.
Sadly, however, as one might well have guessed, there is a truck-sized catch to this proposed change.
Because our state’s Medicaid eligibility standards are so absurdly stingy and cruel, the change will only help a tiny handful of families. Indeed, as Bonner reported, the change will add a relative pittance (around $5 million) to the budget of a $16.7 billion program.
“How stingy and cruel?” you ask. Well, consider the following:
For a non-disabled adult to gain access to Medicaid in our state, they must be both:
- a parent, and
- earn no more than 41% of the federal poverty threshold.
Think about that for a moment.
It’s long been well-documented that the federal poverty guideline (FPG) is an inadequate and obsolete number that comes nowhere near to meeting basic needs of a family in 21st Century America.
What’s more, simple, back-of-the-envelope math (and common sense) confirms that it is essentially impossible for a family of three to survive on the official FPG $21,000 per year or $400 per week.
Now take just 41% of that number and you’ve got North Carolina’s eligibility standard for Medicaid. That’s $8,905 dollars per year for a family of three.
A family trying to survive on, say, $9,500 dollars per year ($183 week!) make too much.
This is, in a word, ridiculous. Who picks a number like this? On what possible findings or facts could it be based?
It’s worth noting that the younger and non-disabled working poor adults denied coverage in North Carolina are not the population that drives up Medicaid costs. As the Kaiser Family Foundation has reported : “Almost two-thirds of all Medicaid spending is for the elderly and persons with disabilities, who make up just one in four enrollees.”
To make matters even more outrageous and cruel, non-disabled adults without kids here are completely ineligible, no matter how low their income.
In most states – those that have expanded Medicaid – the eligibility standard is 138% of the FPG for adults, both with and without kids. And while hardly generous, it’s at least a semi-serious figure that recognizes the obsolescence of the official poverty line.
And some states do even more to help people. (Click here  to examine the national list.)
Naturally, there are a few other bottom-feeder, non-expansion states with which North Carolina competes in the stinginess sweepstakes. Georgia sets eligibility at a miserly 35% of FPG. Mississippi is at 26%. Alabama is at 18%. And the champ, Texas, is at a preposterous 17% of FPG.
But several other states of the old Confederacy – both expansion states like Virginia, Louisiana, and Arkansas and even non-expansion states like Tennessee and South Carolina – are much less-Scrooge-like than North Carolina.
The good news, of course, is that there is a simple and obvious fix to this situation: expanding Medicaid under the terms of the Affordable Care Act.
In one simple step, North Carolina could bring life-saving health care coverage to half a million adults, save thousands of lives, inject billions into the state’s economy, bolster its struggling hospitals and, as a recent study explained , indirectly expand access for children as well.
But wait, as the late-night TV infomercials put it, there’s more!
The federal relief legislation working its way through Congress, would add a cherry to the top of the package for the remaining holdout states. If it expands Medicaid now, North Carolina would realize an additional $2.4 billion over two years  to apply to whatever needs it identifies: healthcare, education, environmental protection – you name it.
The bottom line: As Senator Britt’s bill testifies, the benefits of Medicaid coverage for those lucky enough to be covered are not in doubt. And if North Carolina is going to cover parents with a substance abuse problem who are trying to live on $8,500 per year, the fact that it won’t cover someone with cancer who makes $9,500 is downright ludicrous.