By Lee Storrow
[A version of this column ran in the Winston-Salem Journal on August 14, 2020. It is republished with the author’s permission]
Strengthening health coverage is a crucial part of North Carolina’s public health response to COVID-19. In fact, earlier this year the COVID-19 State Vulnerability Index created by the Surgo Foundation found North Carolina to be the second least prepared state in the country for the pandemic, slightly behind Alabama. This is mainly due to North Carolina’s enormously high rate and growing number of uninsured residents.
The good news is that our ace in the hole has been working to mitigate the impacts of viruses and diseases for decades- Medicaid. Last month the program celebrated it’s 55th birthday, and is leading the way to greater public health. Medicaid has been crucial in our fight against HIV, helping people living with HIV access treatment and covering costs of testing and preventative services for people who are HIV negative. Medicaid has also been critical in our state’s response to the opioid epidemic, helping cover the cost of substance use disorder services along with testing and treatment for hepatitis. When Medicaid helps cure someone of hepatitis or keeps someone living with HIV virally suppressed so they won’t transmit HIV to others, the program keeps our entire state healthy.
Though negotiations have stalled for the moment, hopefully in the coming weeks negotiators from the US House of Representatives, US Senate, and White House will finalize details on the next federal COVID-19 relief package. As they negotiate these final details, Sen. Thom Tillis and Sen. Richard Burr can support North Carolina by supporting an increase in Medicaid funds coming to our state, called the “FMAP (Federal Medicaid Assistance Percentage) bump”.
Medicaid is jointly funded by the federal government and states. In fact, the largest allocation of federal money North Carolina receives is for the Medicaid health insurance program. By increasing the FMAP formula, Congress can maximize Medicaid funding and better prepare our state, and the other 49, to tackle COVID-19 and other public health challenges. This proposed change is different from discussing Medicaid eligibility, which would require the NC general Assembly to pass a state law. Medicaid is a complicated program, and you are forgiven if you confuse the two issues, especially given the amount of conversation about Medicaid expansion in our state this year.
The funds would help North Carolina fight COVID-19 and promote economic recovery. Bolstering Medicaid funding would particularly benefit rural communities, because more families in rural North Carolina rely on Medicaid for their health coverage. North Carolina has already seen Medicaid enrollment begin to grow since the pandemic began. The vast majority of those covered by Medicaid in NC are children under 18, and adults with disabilities. Medicaid is also the single largest source of insurance coverage for people with HIV.
Federal Medicaid funding acts as an economic stabilizer for our state. During the 2009 recession, Congress increased the FMAP by 12% to meet increased needs and protect state budgets. COVID-19 has presented an even larger crisis. A 14% FMAP increase in 2020 would acknowledge the scope of this emergency and bring in nearly $2 billion more per year in federal Medicaid dollars for North Carolina.
In March, as part of the “Families First” COVID-19 response legislation, Congress increased the FMAP by 6.2%. Both of our US Senators, Thom Tillis and Richard Burr, supported this important provision. But now is the time for greater action. Earlier this year, many of us hoped that by August the COVID-19 pandemic would be in our rearview mirror. It’s now clear we need to prepare for the long haul, and that includes shoring up and strengthening Medicaid.
In May, the House passed the HEROES Act, which included the needed 14% FMAP increase for one year. Senators Tillis and Burr should join the House and support that FMAP bump—it is a critical stimulus element for our state. Hundreds of health advocacy organizations, hospitals, physicians, health insurers, and state & local governments are calling on Congress to support the FMAP increase. By injecting more support into North Carolina’s Medicaid program, Congress will ease the strain on both our health systems and our state budget.
Medicaid is one of our strongest tools to combat COVID-19 and the other health epidemics facing our state. Senators Burr and Tillis, the time is now. We need your support for the FMAP bump.
Lee Storrow is the Executive Director of the North Carolina AIDS Action Network.