A cancer patient in North Carolina gets approved for Medicaid. Then a new law says she had to prove she was working 3 months before she applied. She was not working because she was sick. Now she waits. Her next chemotherapy appointment does not.
This is not a hypothetical. It is the direct consequence of what North Carolina's HB 696 proposes, and the American Cancer Society said it plainly on April 22: this bill "will mean more cancer patients forced to forgo treatment, live sicker and die sooner." I believe them.
What coverage gaps actually do to your body
People lose Medicaid and they stop taking their blood pressure medication. They skip the colonoscopy. They manage their diabetes with whatever they can afford at the pharmacy counter, which is not the same as managing it with a doctor. These are not abstract risks. They are the predictable, documented results of coverage gaps.
A JAMA Open Network study found that by the end of their first year on Medicare, 37% of adults who had transitioned from Medicaid had no Medicaid coverage at all. That is more than 1 in 3 people falling through the gap between two programs they were supposed to be covered by. The researchers called it "increased financial burden." I would call it people rationing insulin.
The American Heart Association and American Lung Association issued a joint statement opposing HB 696 four days ago. Their argument is simple: cardiovascular disease and stroke are leading causes of death, and the medications and screenings that prevent them require continuous coverage. Interrupt the coverage, interrupt the care. The biology does not pause for paperwork.
The three-month lookback is not a safeguard, it is a trap
Supporters of work requirements argue they encourage self-sufficiency. That is a fair point to make for people who are healthy and employed. It does not apply to someone who lost their job because they got sick, or who is a caregiver, or who works seasonally and cannot document 3 months of continuous employment on demand.
The lookback period is the specific problem. It does not ask whether you are working now. It asks whether you were working before you needed help. That is backwards. It screens out the people most likely to need Medicaid, which is the opposite of what the program exists to do.
States that simplified their enrollment processes got measurably better results. Research shows that beneficiaries in states without asset tests were 16 percentage points more likely to maintain continuous 12-month coverage. Sixteen points. That is not a rounding error. That is thousands of people keeping their doctors.
North Carolina also just approved a $319 million Medicaid funding package to avoid a May shortfall. The state clearly understands the program matters. The question is whether lawmakers will design it to actually reach the people it is meant to serve.
The proposed $25 co-pay per visit sounds small. For someone on Medicaid receiving weekly cancer treatment, it is not small. It is a reason to skip a session.
I write mostly about what individuals can do for their own health: sleep more, move daily, eat real food. But none of that advice reaches someone who cannot get a prescription filled or a tumor caught early because a three-month lookback period said they did not qualify. The fundamentals of health require access to care first. North Carolina's legislature should strip the lookback provision from HB 696 before it becomes law, because the people it will harm are already eligible. They just cannot prove it fast enough.
