Only 15% of unemployed adults in NC got Medicaid insurance during the pandemic, a study finds


Only 15 percent of adults who became unemployed during the North Carolina pandemic got Medicaid coverage, although the rate was higher in the more socially vulnerable counties of the state.

In the first few months of the pandemic, the US unemployment rate skyrocketed from 3.8 percent in February 2020 to 13 percent in April 2020, quickly exceeding total job losses from the entire two years of the Great Recession. Millions of people forced out of the labor market lost both their income and their employer-funded health insurance.

Medicaid was designed to help cushion the shock of economic hardship, especially during a crisis like COVID-19. But for many people who lost their jobs and often lost health insurance during the North Carolina pandemic, that safety-net health insurance program was not there to support them, according to a new study conducted by a School of Public Health researchers.

Published in the magazine Health matters, the study found that only about 15 percent of North Carolina residents who became unemployed would get Medicaid coverage. Among the 12 states that have yet to expand Medicaid, North Carolina maintains very restrictive licensing requirements for Medicaid for adults.

Our study results aren’t surprising considering how difficult it is to qualify for Medicaid in North Carolina. In essence, as an adult with no children or other dependents, you can never be eligible for Medicaid based on income alone. Parents and caregivers who qualify can only earn incomes up to 41 percent of the federal poverty line (FPL), which is very low compared to expanding states, where anyone can qualify up to 138 percent of the FPL. “

Paul Shafer, Principal Investigator and Assistant Professor of Health Law, Policy, and Management, Boston University School of Medicine

When examining county-level data on unemployment, Medicaid enrollment, and social vulnerability, the researchers also found that North Carolina’s most socially vulnerable counties had higher gains in Medicaid enrollment – good news, Shafer says, but not good enough considering the state’s overall high noninsurance rate: an estimated 20 percent of adults in the state were uninsured as of May 2020.

“It is not enough to say that we are moving in the right direction from an equity perspective,” says Shafer. “The idea that in a post-ACA world one state could have a 20 percent adult non-insurance rate is overwhelming. It is very clear that a significant number of people are losing their insurance coverage and getting nowhere else without the Medicaid extension. “

The results highlight the important role of social context in the relationship between unemployment and Medicaid enrollment. State-wide Medicaid data may not accurately capture differences in unemployment and other barriers to Medicaid enrollment that can occur within a state.

As the country approaches a post-pandemic reality, another threat looms on the horizon. Millions more people are at risk of losing Medicaid coverage if the public health emergency COVID declaration expires and all paperwork and other administrative burdens resume after being stopped during the pandemic.

One obvious solution to ensuring people keep or purchase health insurance is to expand Medicaid across the board, Shafer says.

“Congress can largely eliminate this problem by closing the Medicaid loophole and adopting strategies such as automatic enrollment that drastically reduce the administrative burden for authorized persons,” he says.


Journal reference:

Shafer, PR, et al. (2021) Association of Unemployment with Medicaid Enrollment by Social Vulnerability in North Carolina During COVID-19. Health matters.

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