NC wants to require Medicaid recipients to work. Here’s what would have to happen next.

North Carolina could be among the first states in the country to require Medicaid beneficiaries to hold down a job as a condition of receiving free health insurance from the government.

The federal law covering Medicaid, the federal health insurance program for the poor, the disabled and for children of low-income parents, doesn’t allow states to force beneficiaries to work, but the Trump Administration said last week it would consider waivers to the law. It granted the first waiver Friday to Kentucky, one of 10 states, including North Carolina, that requested the waiver. (Of the states requesting the waiver, North Carolina is the only one with a Democratic governor.)

The N.C. Department of Health and Human Services made its request in November as part of a broader request to change the way Medicaid is administered. If approved, the work requirement would not automatically go into effect; it is contingent on the N.C. General Assembly passing House Bill 662, known as Carolina Cares. The bill would expand Medicaid to several hundred thousand residents – but with conditions, including that they pay monthly premiums for their government health insurance, and that they work.

Here’s what you need to know about Medicaid in North Carolina and the current proposal.

Q: How many people are on Medicaid in North Carolina?

A: Just over 2.1 million, about half are infants, children and youths. It also covers people with disabilities and low-income seniors.

Q: Would all those people be forced to work if North Carolina’s request were granted by the Centers for Medicare and Medicaid Services?

A: Actually, none of the 2.1 million would have to work. If North Carolina’s waiver is approved, it would apply only to people included in an expanded Medicaid program, which as we’ve pointed out would have to approved by the General Assembly. The expansion would apply to people who are not considered disabled, between the ages of 18 and 64, and whose incomes are at or below 133 percent of the Federal Poverty Level. They are often referred to as the working poor and don’t have health insurance at work or can’t afford health insurance. To encourage the state’s Republican legislature to expand Medicaid to this group of people, Democratic Gov. Roy Cooper’s administration has included a work requirement in its Medicaid overhaul proposal.

Q: How many additional people would get Medicaid if the program were expanded?

A: Estimates range from 300,000 to 500,000 in North Carolina.

Q: Would all of these people have to work to receive Medicaid benefits?

A: No. North Carolina would exempt certain people: Those who are caretakers of children, of disabled adult children or of disabled parents; those receiving treatment for substance abuse; and those who are medically frail. It’s not clear how many people these exemptions would cover.

Q: What about the rest?

A: The rest would likely have to work. But it is also likely that most of them are working already. The independent Kaiser Family Foundation estimated this month that in North Carolina, 76 percent of the people who could qualify are in a household where someone works, and 57 percent work for themselves. The number of people not working is likely to be under 100,000, estimated health care lawyer Curtis Venable. But Venable noted that some of those people would be exempted from having to work because of extenuating circumstances, such as poor health or other obligations.

Q: The ones who do work – what kinds of jobs do they have?

A: Low-income jobs in construction, restaurants, retail, food industry, discount stores, nursing home facilities, day care centers, hospitals, elementary schools and the like, according to the Kaiser Family Foundation.

Q: What is the status of North Carolina’s Carolina Cares bill?

A: It was introduced in the state legislature last April by four Republicans – including Donna McDowell White of Johnston County – and has sat untouched since then.

Q: Does the lack of legislative activity mean the Carolina Cares bill is dead on arrival, and that the Medicaid work requirement is a long shot?

A: Not necessarily. Last year, Congress and Trump were focusing on repealing the Affordable Care Act, so it was unclear what the nation’s health care landscape would look like this year, and other health care initiatives were put on a back burner. The ACA repeal didn’t happen and Republicans have shifted their focus. Trump has just proposed the work requirement as a new Medicaid policy, so there could be revived interest in Raleigh in the Carolina Cares bill.

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