A recent proposal by President Donald Trump's administration could change the way Medicaid functions in some areas.
The Healthy Adult Opportunity (HAO), a block-grant program, would let states opt-in to a lump-sum funding base to pay for the health care needs of low-income adults.
Many critics, and most Democratic lawmakers, have said the HAO "threatens the bedrock principles of the federal safety-net program," potentially leading to health needs going unmet, according to North Carolina Health News.
North Carolina Gov. Roy Cooper | North Carolina Attorney General's Office
North Carolina is one of 14 states that has decided not to expand Medicaid services to low-income adults. Democratic Gov. Roy Cooper is in favor of Medicaid expansion, however, and vetoed the most recent budget proposal because it did not allocate funds for expansion.
Cooper says he is not interested in the HAO either, a statement from his spokesperson confirms.
“Gov. Cooper’s goal is to increase access to health care, not take it away, and he is focused on expanding Medicaid to help more hardworking North Carolinians get coverage that will lower health insurance premiums for everyone,” Ford Porter told North Carolina Health News.
A statement from the North Carolina Department of Health and Human Services also expresses reluctance toward the HAO.
“By design, block grants can take health care away from people and leave states on the hook for millions of dollars,” the statement said. “We remain focused on responsible solutions that help North Carolinians get affordable health care, not take it away from them.”
Currently, states receive federal aid on an as-needed basis. Claims for services are submitted and the state pays the providers directly.
Participation in the HAO is optional for states and would not affect children, the elderly or those with disabilities who currently receive Medicaid. It will give states the opportunity to specifically design coverage for low-income adults who are not eligible for coverage due to a disability.
Critics of the program, including Leo Cuello of the National Health Law Program, warn that block grants could disrupt the federal government's commitment to pay for state Medicaid needs.
“These block grants would be devastating for any state that attempts to implement them,” Cuello told North Carolina Health News. “Any irresponsible state leader that pursues this policy will be acting against his or her state’s interests – harming the state budget, rural hospitals, state health insurance coverage – and the people who depend on Medicaid for their health insurance coverage.”
Critics also worry that approval of this cap could lead to future cuts in funding.
North Carolina's Medicaid system, providing care for some of the state's most vulnerable residents, currently covers just over 2 million residents. More than half of those are children.
In 2018, North Carolina's Medicaid cost was $14.8 billion, and more than 65 percent of those funds came from the federal government.