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Medicaid Expansion in North Carolina

Many North Carolinians believe that Obamacare’s Medicaid expansion is a deal too good to pass up. Most of them are not taking the time to look beyond the partisan talking points.  Why wouldn’t North Carolina want to offer “free” health insurance to more than half a million residents and only pay for 10 percent of the cost, since the feds promise to cover the rest of the tab?

Such a significant policy change for such a complex program cannot be viewed so simply. There are severe fiscal and human costs associated with Medicaid expansion that deserve a closer examination.

States that have decided to massively inflate the welfare state to people who have never qualified for long-term government benefits, chiefly able-bodied childless adults, are now faced with administrative failures and bleeding budgets. Audits are consistently discovering significant Medicaid eligibility error rates. Those who should qualify are denied, while others who are not eligible are benefiting from the program.

According to the U.S. Department of Health and Human Services’ Inspector General’s Office, 25% of Medicaid expansion enrollees in California and New York were likely ineligible. Couple that with New York’s Medicaid program being $3 billion over budget, and you’ve got a recipe for a budget boondoggle.    

It’s a laudable goal to ensure that everyone has health insurance, but the path many states have chosen to depend on government subsidies to accomplish that. This does nothing to improve the health care industry’s affordability crisis, nor does it guarantee patients better access to care – especially in areas where physicians are scarce. Adding more people to North Carolina’s already-strained Medicaid system will further deteriorate access to medical services for low-income children, parents, the elderly, and blind or disabled individuals. The average wait time to see a family physician is three weeks.  

Instead of piling more federal debt onto future generations, North Carolina has taken a more fiscally responsible approach with plans to improve the value of our existing Medicaid program and to invest in local organizations that provide medical care to low-income and uninsured people.

Thanks to leadership efforts at North Carolina’s Department of Health and Human Services, we’ve been awarded $650 million over the next five years to improve Medicaid patients’ overall wellbeing. More people are embracing the fact that 80% of a person’s overall health is unrelated to medical care. This is why addressing issues like homelessness, domestic violence, and food deserts are paramount.

This pilot program, known as Healthy Opportunities, is an integral part of North Carolina’s transition to Medicaid Managed Care. This concept of connecting people to non-medical community resources is already happening through NCCare360, a privately funded nonprofit. Since its inception in 2019, NCCare360 Navigators have made over 1,000 referrals for financially distressed residents who are seeking housing, transportation, and health care assistance in their communities. Unfortunately, the ability for the DHHS to scale this model has been put on hold, thanks to Governor Roy Cooper’s veto of the state budget and a stand-alone Medicaid transformation funding bill.

Governor Cooper’s Medicaid expansion ultimatum is not only stymieing Medicaid Managed Care, but it’s depriving North Carolina’s most vulnerable citizens of hundreds of millions of dollars in DHHS investments. His vetoes mean nearly $10 million for emergency shelter services across the state and more than $50 million for rural health services is out of the picture. It means that 1,000 children with intellectual and developmental disabilities won’t be able to access home and community support services. It means that $16 million dedicated to targeting the opioid crisis, mental health and substance abuse disorders is nonexistent. It ignores the legislature’s attempt to increase wages for group home personnel who assist people with intellectual and developmental disabilities.

It’s a fallacy to believe that solving the state’s health care crisis can be done by expanding Medicaid. Instead of accepting a fraught system, North Carolina needs to improve its current Medicaid programs and extend care to those who need it the most.