Statement from the American Heart Association and American Lung Association on Proposed Medicaid Eligibility and Coverage Changes for North Carolina

The American Heart Association and the American Lung Association are concerned that provisions in HB 696 CCS would create new barriers to timely, continuous, and affordable Medicaid coverage. Access to health coverage is a critical foundation for preventing and managing cardiovascular disease and stroke, as well as lung cancer and chronic lung diseases – among the leading causes of death - and for helping people access the medications, screenings, and primary care they need to live longer, healthier lives.

Compliance reporting lookback periods: Requiring individuals to prove compliance for three months prior to application and for at least three of the six months prior to renewal is more stringent than necessary and risk delaying or denying coverage for eligible individuals due to paperwork hurdles. We urge policymakers to adopt a more reasonable standard that supports timely access to Medicaid and reduces avoidable coverage gaps.

Eligibility monitoring burden and churn: Increasing eligibility information checks from quarterly to monthly raises administrative burden and heightens the risk that data mismatches or errors could trigger administrative disenrollment. When people lose coverage for procedural reasons, they often delay care, go without needed prescriptions, and experience interruptions in treatment—all of which can worsen chronic conditions, including cardiovascular disease, asthma, COPD, and other serious lung diseases.

Verification and self-attestation: While strong program integrity is important, overly restricting self-attestation can increase red tape for applicants and renewals and add costs for the state to administer. We encourage the legislature to preserve appropriate flexibility, including the use of self-attestation where it supports accurate and efficient determinations and helps eligible people maintain coverage to continue managing chronic heart and lung conditions.

Cost-sharing at maximum levels: Setting co-payments at the highest levels allowed can deter people from seeking necessary care. Even nominal costs can cause individuals to skip appointments and medications, especially those managing chronic health conditions such as heart or lung disease, including asthma, COPD, or lung cancer, as well as high blood pressure, or diabetes, which can lead to preventable complications and avoidable emergency room use. We urge the state to set cost-sharing at the minimum required by federal law to protect access to essential services.

The American Heart Association and the American Lung Association stand ready to work with policymakers to advance solutions that protect health, reduce health care costs over time, and improve outcomes for communities across our state.