NC Republicans renew their support for Medicaid work requirements, while Democrats say ‘no'

Yahoo

01-04-2025

Legislators were divided Tuesday over a move intended to smooth the way for North Carolina to require people who gained health insurance though Medicaid expansion to work.
Republicans on the House Health Committee voted in favor of House Bill 491, which its sponsor, Rep. Donny Lambeth (R-Forsyth) described as a signal to Washington decisionmakers that state legislators support work requirements. Nearly all Democrats on the committee voted no. Rep. Carla Cunningham (D-Mecklenburg) abstained.
Rep. Garland Pierce (D-Scotland) said after the committee meeting the bill wasn't 'fully vetted.'
Rep. Becky Carney (D-Mecklenburg) said the bill 'wasn't ready for prime time,' though Lambeth 'did what he thought was right.'
North Carolina's 2023 Medicaid expansion law already includes a provision requiring the state Department of Health and Human Services to pursue work requirements if it seems federal administrators will allow them. The federal government sets baseline requirements for Medicaid coverage and pays most of the bill. States must ask permission before changing their Medicaid programs.
Under President Donald Trump's first administration, state requests to impose Medicaid work requirements were approved. Courts overturned some of those approvals and President Joe Biden's administration later rescinded others.
Congressional budget-cutters are now considering work requirements as a way to save money in the Medicaid program. Along with work requirements and other cuts, Congressional Republicans are also considering a reduction in the 90% in funding support the federal government currently provides to states for people covered under Medicaid expansion.
North Carolina's Medicaid expansion law includes a trigger that would end Medicaid expansion, which would withdraw health insurance from more than 600,000 people, if the federal government's support falls below 90%. None of the money for people insured under Medicaid expansion comes from state coffers.
Lambeth's bill requires the state Department of Health and Human Services to tell the legislature how much money is needed to implement a work requirement and says it would be imposed regardless of another state law on income thresholds and eligibility categories.
'It basically reiterates what the current expansion bill already says, signaling to the folks in Washington we'd be supportive of that if we got to that point,' Lambeth told the committee.
'I'm hoping by signaling we're okay with a work requirement, they will get off the idea of changing our funding formula. If the funding formula is changed, even a small tenth of a percent, one percent, it is a major impact to North Carolina, and we hope we don't have to go down that path.' Lambeth has stated previously that a reduction in federal support would be 'a disaster.'
Rep. Sarah Crawford (D-Wake) co-sponsored a bill that would get rid of the trigger. Under that bill, Medicaid expansion in North Carolina would be spared if the federal government's financial support falls below 90%.
Crawford voted against the work requirement bill.
'There is no evidence that work requirements actually increase work participation,' Crawford said after the committee meeting. Most adults who use Medicaid as their insurance and are able to work already do. 'About eight percent of people on Medicaid who are able to work are not working, so it's a relatively small number of people. Those individuals typically have a number of barriers to employment that include a whole host of things — where they live, their health, access to transportation. All that we've seen in the past, when other states have tried to implement work requirements, it actually leads to be people being left without coverage.'
Arkansas imposed a Medicaid work requirement for less than a year in 2018 before a judge ended it. About 18,000 people lost their health insurance, according to a study, and the work requirement did not lead to increased employment. Arkansans were not able to report their work hours due to lack of internet access, didn't know about the requirement, or didn't think it applied to them, a 2019 study said.
Stateline reported Tuesday that between 4.6 million and 5.2 million adults ages 19 to 55 could lose their health care coverage under an emerging congressional Republican plan to impose Medicaid work requirements nationwide.
Lambeth said after the meeting that the work requirement would cover people who gained insurance under Medicaid expansion. In that case, people with disabilities who are insured under special Medicaid programs would be exempt.
Lambeth worked for years to extend Medicaid coverage to more adults, and for a long time he was one of the few Republicans in the legislature openly supporting it. He sponsored bills that were precursors to the 2023 Medicaid expansion law that included work requirements.
Including the requirement for at least 90% federal funding in the 2023 expansion law was one of the conditions for winning greater Republican support, he said.
'The only way we got that bill approved was to have triggers in there,' Lambeth said. The 90% trigger and work requirements were necessary to 'cobble together enough Republican votes.'