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Defenders of Justice
Justice Circle Brief from NC Justice Center’s Health Advocacy Project also highlights stories of individuals who are struggling to manage chronic conditions while living without insurance
RALEIGH (June 11, 2019) – Many North Carolinians living in the Medicaid coverage gap have disabilities, chronic illnesses, and substance use disorders, and are falling through the cracks of the state’s current system, according to a new report from the NC Justice Center’s Health Advocacy Project.
“Contrary to popular belief, people living with disabilities in poverty are not automatically eligible for public health insurance coverage, nor does a diagnosis of a life-threatening disease or chronic illness qualify someone for Medicaid in North Carolina,” said Brendan Riley, policy analyst with the Health Advocacy Project and author of the report. “While both programs offer coverage to some people with disabilities, Medicaid and Medicare exclude far too many people with disabilities and serious medical conditions. Just yesterday 30 organizations and individuals, including health care providers, advocates, and caregivers for people with disabilities, chronic illnesses, and complex medical needs issued a statement in support of closing the gap.”
More than 54,000 uninsured people with disabilities are living in the coverage gap, according to the report, including North Carolinians with cognitive difficulties and those who have trouble walking, bathing, dressing, and performing other activities of daily life on their own. North Carolina Medicaid uses a narrow definition of disability that excludes many North Carolinians with American With Disabilities Act-defined disabilities as well as people with a wide range of chronic and complex medical conditions.
Even North Carolinians who do meet strict definitions of disabled or blind must clear other hurdles to qualify for Medicaid, including having both below-poverty income earnings and minimal assets, as low as $2,000 for an individual. This means otherwise eligible North Carolinians with disabilities living in poverty with modest savings may not qualify for N.C. Medicaid, the report said.
Many others in the coverage gap have chronic conditions and complex medical needs. Roughly 150,000 uninsured North Carolinians who have substance use disorders and/or mental illness could gain coverage if the state closes the gap, allowing them to afford care and treatment. Other estimates suggest closing the coverage gap would result in 641 new cancer diagnoses a year, including 291 new early-stage cancer diagnoses.
Closing the coverage gap has had proven results in other states, the report said, where individuals with disabilities have directly benefited. The uninsured rate for nonelderly adults with disabilities in coverage gap states fell from 19 to 15 percent on average, while states that closed their coverage gap have seen uninsured rates among disabled adults fall from 16 to 6 percent.
The report also highlights research showing no negative relationship between Medicaid expansion and availability of home and community-based services for people with disabilities. North Carolina can both close its coverage gap and add Innovations Waiver slots to support more people with intellectual and developmental disabilities in need of home and community-based services; in fact, closing the gap will produce state budget savings which lawmakers could use to fund new slots, the report said.
“Closing North Carolina’s coverage gap would let all nonelderly adults with low incomes who have disabilities, complex medical needs, and chronic illnesses access affordable health coverage, which would allow them to receive regular care and treatment for their conditions while protecting against financial ruin,” Riley said. “It’s time to close the gap so that our communities can afford the care they need.”