Two identical bills introduced this week in the North Carolina House and Senate would update the language on work requirements that is part of the 2023 law expanding Medicaid in North Carolina.
Rep. Donny Lambeth (R-Forsyth), a primary sponsor of House Bill 491, said it is intended as a signal to Republicans in Washington that North Carolina is okay with work requirements, and written in the hope it will ward off federal budget cuts that would threaten the existence of Medicaid expansion in the state.
The state’s 2023 expansion law includes a trigger that will end Medicaid expansion if the federal government alters the funding formula and decides to cut how much it pays. The federal government now covers 90% of the cost for people covered under Medicaid expansion.
Rep. Donny Lambeth (Photo: ncleg.gov)“I thought that if we were proactive on the work requirement and silent on the formula change, my hope is the feds will not mess with the formula,” Lambeth said. Changing the formula “would be a disaster,” he said. “It puts the whole program at risk.”
About 640, 000 North Carolinians have enrolled in expanded Medicaid since its launch in December 2023. They are adults younger than 65 without dependent children who make less than 138% of the federal poverty level.
Work requirements and reducing the federal contribution to states for people covered under expansion were among the options for Medicaid cuts included in a recent U.S. House budget committee document.
North Carolina’s expansion law already requires the state Department of Health and Human Services to ask the federal government for permission to impose work requirements on Medicaid expansion beneficiaries if “there is an indication” that the Centers for Medicare & Medicaid Services (CMS) would approve. The new bills add that DHHS must implement work requirements that receive the federal government’s okay.
In President Donald Trump’s first term, CMS approved states’ plans for Medicaid work requirements. Some of those plans were later invalidated by federal courts. President Joe Biden’s administration rescinded permission granted to other states.
With Trump back in charge, Republicans at the state level see another chance to have Medicaid work requirements approved.
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 in Arkansas, according to a study, and the work requirement did not lead to increased employment.
Arkansas Governor Sarah Huckabee Sanders is again seeking permission for a work requirement, the Arkansas Advocate reported. Governors in South Carolina and Ohio are also seeking permission for Medicaid work requirements.
Lambeth is a longtime supporter of work requirements as a qualification for adults’ health insurance coverage. Bills he sponsored that were precursors to the Medicaid expansion law included work requirements for participants.
About 80% of people who gained insurance coverage under expansion are already working, Lambeth said Tuesday.
The bills stop short of requiring DHHS to apply for permission to impose work requirements.
Rather than wasting time seeking something that won’t be approved, it would be good to see whether courts allow work requirements as part of Medicaid expansion in other states, Lambeth said.
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