North Carolina Senate committee approves legislation to expand Medicaid access

The North Carolina Senate Health Committee passed two bills Thursday that would expand Medicaid access for inmates and postpartum mothers, redefine child welfare regulations, and implement steps biological fathers can take in a child’s adoption process.

The former of the two bills received no public comment the previous day, when the legislation was discussed. The latter, however, drew skepticism from those involved in adoption services.

Here’s a look at the two bills.

Medicaid-expansion bill emphasizes inmates and infants

HB564, “Medication Modernization,” would suspend rather than terminate Medicaid access for inmates serving jail time. The bill intends to re-align state with incoming federal law and lower recidivism rates, according to the bill’s sponsor, Republican Rep. Donna White.

Federal law prohibits inmates from receiving Medicaid access while in jail. Inmates are instead directed to receive health services from the county.

Under current state law, prisoners released from jail don’t have Medicaid coverage reinstated. They are eligible to reapply, but the process takes about 45 days for standard applications and up to 90 days for disability applications. Meanwhile, recidivism rates remain around 40%, with most re-arrests taking place within six months of an inmate’s release. Immediately resuming Medicaid access for inmates upon their release will give them the added care and support they need to get on their feet, White said.

The bill also details plans to develop a “Medicaid team-based care coordination” under North Carolina’s Department of Health and Human Services and the Division of Health Benefits. The service would carry out screening and treatment for drug use disorder among other medical examinations.

Democratic Sen. Val Applewhite raised concerns over DHHS’s ability to execute this legislation under ongoing constraints from continued staffing shortages. White acknowledged the limitations DHHS is facing. But, she said conversations between legislators and DHHS over the proposed bill were met with support and a commitment to its execution. When Applewhite asked for confirmation over whether DHHS’ current staff size could withstand the legislation’s needs, Republican Sen. Jim Burgin said he would report back.

The bill, which Republican Sen. Amy Galey presented to the committee Thursday, would also grant Medicaid access to new mothers up to 12 months after giving birth. A similar 2021 plan provided the same timeline of Medicaid support to postpartum mothers; however, the act’s power expires in 2027. Solidifying the 12-month time frame for mothers will improve infant health and mortality rates, Gayle said.

White and Galey noted the racial disparity in infant mortality rates. They said the legislation intends to lower the gap in mortality rate between white and Black infants, which is around 4.7% and 12.9%, respectively, according to most recently available data from a 2022 North Carolina Center for Health Statistics report.

While the data is slim, Galey also said available evidence suggests healthier mothers equate to healthier infants. If mothers have the added support of Medicaid benefits during a child’s first year of life, then the child can also reap those benefits, Galey added.

Biological parents’ rights in adoption processes

HB612, “Fostering Health Care in NC Act,” would change child welfare laws and the state’s adoption processes.

Under the legislation, the definition of “abused juveniles” will expand to include victims of human trafficking and mandates assessment within 24 hours for abuse and 72 hours for neglect. Conflicts of interest within social service cases will also be snuffed out, and relevant cases will move to a different county to preserve impartiality.

While public comment didn’t touch on the aforementioned parts, controversy stemmed from the legislation’s overhauls of the state’s adoption services.

One section of the bill outlines scenarios in which a child’s biological father must give consent for adoption. This includes cases where the father does not know he was the biological father and can prove the biological mother committed fraud in withholding that information. Another portion of the bill would enforce a post-adoption contract between a child’s biological parents and prospective adoptive parents before the adoption is solidified.

Sheryl Nayor, senior director of domestic adoption at Christian Adoption Services, told the committee Wednesday she had concerns over the bill’s ability to disrupt the adoption process and limit the influence of “professionals who have spent decades facilitating ethical, compassionate and child-centered adoptions.”

The added protections for biological fathers to be involved in the child’s adoption process are vague and ambiguous, Naylor said, and could open a door for an adoption case being interrupted.

Democratic Sen. Julie Mayfield said she received concerned emails from citizens who spoke during Wednesday’s public comment. She asked to confirm if the statute distinguishes between fathers who are aware of the child before the birth and took steps to engage in preparations and those who did not know of the child’s existence until after the birth.

One of the bill’s sponsors, Republican Rep. Allen Chesser, said the statute did not distinguish between the two cases. “The only significant change,” he added, is for a biological father looking to be involved in their child’s custody or adoption process to file a petition.

“Courts already say burden under current law is too stringent for fathers to achieve,” Chesser said.

The legislators were continuing to work with stakeholders, Jarvis added.

After a legal notice of a potential adoption process is delivered to the biological father, he generally has 30 days to act under current law. If he takes no action, the court may proceed with the adoption process. Parental rights and responsibilities are terminated once an adoption is finalized, with the exception of paying past-due child support.

The bills will move on to Rules and Operations of the Senate committee. If approved, they will reach the Senate chamber for a vote.