Point of View

NC Senate budget plan pushes pregnant women out of Medicaid

May 29, 2013 

Largely unnoticed and unremarked in the budget recently passed by the N.C. Senate was a troubling reduction in the eligibility of pregnant women for the state’s Medicaid program.

While Republicans have made it clear they don’t want to accept federal money to expand the state’s Medicaid program under the Affordable Care Act, this attempt to cut eligibility levels for women currently on Medicaid marks a new effort to limit health options for low-income North Carolinians.

The Senate provision claims lower-income pregnant women will be able to buy coverage with a state subsidy in the private insurance market, a hope that is not realistic given that the Affordable Care Act was set up assuming states would expand, not restrict Medicaid.

With this change, the N.C. Senate willfully ignores the successful bipartisan history of our expansion of Medicaid for pregnant women in our state and the terrible cost both in money and infant health such a reduction will mean.

Back in 1989, shortly after news that North Carolina had the highest infant mortality rate of any state in the nation, Republican Gov. Jim Martin created a task force to seek solutions to this national embarrassment after he already had been pushing for changes to address the problem. Solutions championed by Martin included expanding Medicaid to many more pregnant women in 1987. The infant mortality rate started to decline quickly.


Martin eventually gave the majority of the credit for the decline to the expansion of the Medicaid program to pregnant women.

After a few years, expanding Medicaid (during their pregnancy only) to pregnant women at 185 percent poverty level, an initiative called “Baby Love” in North Carolina, was a smashing success. Not only was the infant mortality rate declining but, by keeping newborns healthy and out of hospital intensive care units, the state Medicaid program was saving significant money.

By 1993, then N.C. Secretary Human Resources Robin Britt was saying, “Every dollar spent on the state Baby Love program results in a savings of $2.02 on Medicaid costs.” While the central pillar of the Baby Love program was the expansion of Medicaid to pregnant women, it was just one part of the comprehensive approach that Martin’s administration took to fight infant mortality.

Because lower-income pregnant women could easily get Medicaid, Baby Love was able to coordinate maternity care through the program and include health education for everyone and home visits for women with higher risk pregnancies. The Baby Love program, one of the first attempts in North Carolina to comprehensively not just deliver health services but to coordinate those services and make sure they were effective, became a model for North Carolina’s moves to coordinate care for the majority of people on Medicaid.

Over the years, the seed planted by the Martin administration grew into a comprehensive approach to managing the care delivered to people on Medicaid, called Community Care of North Carolina. These efforts have saved state taxpayers over a billion dollars and given effective and quality health care to the lowest-income residents of our state.

Over the last 20 years, North Carolina has gone from an annual growth rate in Medicaid costs of 14 percent to today’s 3.5 percent grown rate (the lowest in the nation). North Carolina leads the nation in reducing Medicaid growth responsibly.

It is no exaggeration to say that because of Martin’s efforts the lives of thousands of North Carolina’s children were saved and continue to be so. It is also no exaggeration to say that because of Martin, North Carolina was able to start on a path to drastically lower spending growth in its Medicaid program and save taxpayers enormous amounts of money over the years.

Republicans currently in the N.C. Senate have ignored this history and passed a budget taking us back to a future of high costs and high infant mortality rates, a move precisely in the wrong direction.

Adam Searing is project director of the Health Access Coalition, part of the N.C. Justice Center.

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