N.C. developing plan to improve Medicaid participants’ job prospects

By Jaymie Baxley

Medicaid expansion has already provided more than 450,000 low-income North Carolinians with health insurance. Could it also help them find better-paying jobs?

State lawmakers believed that was the case when they approved legislation making North Carolina the 40th state to expand access to Medicaid in March 2023. The law, which officially took effect in December, included a provision requiring the N.C. Department of Health and Human Services to collaborate with the state’s Department of Commerce to craft a plan for “assessing the current employment status and any barriers to employment” of adults who gained Medicaid through expansion. 

Work on that plan began in earnest on May 15 at DHHS’ headquarters in Raleigh, where a group of about 30 stakeholders with backgrounds in education, health care and economic development gathered for a brainstorming session. Their feedback will be used to create a comprehensive proposal to be presented to the General Assembly later this year. 

Anita Brown-Graham, director of the ncIMPACT Initiative for UNC Chapel Hill’s School of Government, is facilitating the project. She said the goal is not to establish a work requirement for Medicaid — something Georgia did last year with less-than-stellar results. 

North Carolina’s plan, Brown-Graham said, will instead focus on “upskilling people who already have jobs in local communities.”

“We’re trying not to make the process too onerous, but we also want to be sure that this process will reach the highest impact possible,” she said. “We’re going to really lean into robust conversations around what this work could mean for the workforce, but also for the health of North Carolinians, which, at least in my perspective, is the end goal.”

‘Rewarding careers’

Expansion raised the state’s income limit for Medicaid, extending eligibility to people who make up to 138 percent of the federal poverty level based on their household size — which calculates to about $35,600 a year for a family of three. The previous limit was 100 percent.

DHHS Sec. Kody Kinsley said the state’s Medicaid rolls have grown at a “breakneck pace” in the months since expansion went live. Expansion-qualifying residents accounted for about 15 percent of North Carolina’s 2.9 million Medicaid enrollees at the beginning of May.

“North Carolina’s expansion growth has been one of the fastest in the nation when we look at that compared to other states,” said Kinsley, who added that the state is “already three quarters of the way to our two-year goal” of 600,000 sign-ups.

He noted that most of the new beneficiaries already have jobs.

“For the Medicaid expansion population, we know that roughly 80 percent of these folks were working already,” Kinsley said. “By definition of being in the gap, they were earning too much money to actually qualify for Medicaid before — but not enough to be able to afford health insurance.”

Health care advocates in North Carolina began pushing lawmakers to expand access to Medicaid after the Affordable Care Act was implemented in 2012, but their efforts were repeatedly thwarted by Republicans in the General Assembly. The promise last year of more than $1.6 billion in federal financial incentives prompted the state’s GOP leadership to reconsider, and expansion passed with bipartisan support. 

The workforce development plan, Kinsley said, is a “perfect opportunity for us to use these dollars in a way that renders great value for people and solves one of our greatest challenges, which is how tight our workforce is right now in North Carolina considering how fast it’s growing,” 

Machelle Baker Sanders, secretary of the Department of Commerce, agreed. Expansion, she said, “represents an investment in North Carolina’s most valuable asset – our people.”

“As we have emphasized in our First in Talent economic development plan, a strong, healthy workforce is essential to our state’s success,” Sanders, who was unable to attend the meeting, said in a statement. “We are looking forward to working together with our partners in identifying opportunities for increased workforce services, so people can build rewarding careers.”

Under the timeline proposed by Brown-Graham, stakeholder committees will spend the summer compiling reports for DHHS and the commerce department. The two agencies will work together through the fall to create a draft proposal for lawmakers. 

While it’s too early to know what specific services that proposal might include, it is expected to cover “job training assistance, career paths and job readiness, job placement, resources for job seekers, recruiting services and healthcare workforce support,” according to a news release from the Department of Commerce. It will also establish methods to “determine the success of workforce development programs,” the department said.

“We’re excited about the partnership and excited about what we’ll do in this project in particular, which is not a work requirement but an opportunity to get folks in the Medicaid world into more of the supportive services that we know they need,” Jordan Whichard, the department’s chief deputy secretary, said during the meeting.

Plan has precedent  

North Carolina is not the first state to attempt to improve residents’ job prospects through Medicaid expansion.

Montana, which expanded Medicaid in 2015, offers voluntary employment services to enrollees through its HELP-Link program. According to the program’s website, any Montanan on Medicaid can use HELP-Link to “meet one-on-one with a qualified career coach to discuss and design a career action plan.”

Data from the Montana Department of Labor and Industry showed that 2,217 people received services through HELP-Link from 2016 to 2023. More than 400 of the program’s clients went on to obtain occupational certifications or licenses. About 250 of them earned college degrees.

In 2022, Kentucky launched an initiative to “boost workforce participation” among enrollees by providing better dental, vision and hearing coverage. Gov. Andy Beshear said the effort was meant to eliminate some of the hurdles — such as disabilities — that kept Kentuckians from finding jobs or advancing their careers.

“If you can’t see, it’s really hard to work,” he told the Associated Press. “If you can’t hear the instructions that you’re getting, it’s really hard to work. If you have massive dental problems that are creating major pain or other complications, it’s really hard to work.”

In Kinsley’s view, it makes sense to use expansion as a vehicle for employment services. Work and health, he said, “go hand in hand.”

“The opportunity to help support people into gainful employment is not only a strategy that helps build their overall health and well-being and social connection and cohesion, it’s potentially a path to give them access to [non-Medicaid] health insurance,” Kinsley said.