Health & Family

Many low-income N.C. workers are locked out of Medicaid

They’re construction workers, waitresses and cashiers. They care for our children and elderly parents, clean our offices and bathrooms.

But they go without health insurance because their incomes aren’t high enough to qualify for federal subsidies and too high to qualify for North Carolina’s current Medicaid program for low-income and disabled citizens.

More than half of the 689,000 uninsured adults North Carolinians who fall into this so-called “Medicaid gap” are employed in jobs that are critical to the state’s economy, according to a report released Thursday by the North Carolina Justice Center, the North Carolina Community Health Center Association and Families USA.

“Expanding Medicaid would help them gain access to affordable care… which would lead to healthier and more productive workforce. And that’s good for business,” said Dee Mahan, Medicaid program director for Families USA, a Washington-based consumer advocacy group.

Under the Affordable Care Act, the expansion of Medicaid provides insurance for residents whose household incomes are less than 138 percent of the federal poverty level. That is $27,310 for a family of three.

North Carolina is one of about 20 Republican-led states that chose to reject that option. Without Medicaid expansion, people in the “gap” are allowed to purchase private insurance through federal or state online exchanges, but they are not eligible for premium subsidies. Authors of the law assumed people in this income bracket wouldn’t need subsidies because they would be covered by Medicaid expansion.

In rejecting expansion last year, Republican Gov. Pat McCrory said it would be unwise to expand the state’s “broken” Medicaid system, which has been plagued by cost overruns. He also expressed doubts about whether the federal government would pay its share of the cost in light of the U.S. budget deficit.

Earlier this month, McCrory told a Charlotte radio interviewer that he is willing to consider Medicaid expansion. “I’m leaving that door open,” he said. “Once we fix the current system, I have not closed that door as governor.”

Under the Affordable Care Act, also known as Obamacare, the federal government would pay the full cost of expanding Medicaid through 2016. After that, the federal share gradually falls to 90 percent in 2020, where it would remain.

Currently, North Carolina’s Medicaid program sets an annual income eligibility ceiling of $9,900 for a family of three. And it does not apply to adults without dependent children. Under this program, the federal government pays 66 percent of the cost, and the state pays the balance.

The Families USA report, based on a U.S. Census survey, found that, among the working poor in North Carolina, 59,000 are employed in construction jobs, 56,000 in food service, 43,000 in cleaning and maintenance jobs, 34,000 in transportation jobs such as bus and taxi drivers, 18,000 in personal care, such as barbers and child care workers, and 16,000 in health-care support, such as home health aides and nursing assistants.

“We’ve been holding meetings across the state, in rural areas and in low-wealth counties. We always run into working families who can’t believe they don’t qualify for anything because of a state decision to refuse Medicaid expansion,” said Adam Linker, a policy analyst with the North Carolina Justice Center, a Raleigh-based consumer advocacy group.

“A lot of these parents were working good jobs, then the recession hit and they lost their jobs, and they’ve gone back to work, often times at low-wage jobs just to get by.…They make too little to qualify for subsidies in the marketplace. Hundreds of working families are falling through the cracks.”

Editor’s note: If you fall into this coverage gap, please contact reporter Karen Garloch