U.S. Rep. Julie Fedorchak speaks in the North Dakota Senate chamber on Feb. 18, 2025, as Lt. Gov Michelle Strinden presides over the session. (Michael Achterling/North Dakota Monitor)
By: Michael Achterling
WASHINGTON (North Dakota Monitor) – North Dakota U.S. Rep. Julie Fedorchak described Medicaid as an “at-risk program” unless reforms are adopted to curb rising costs.
But North Dakota advocates for Medicaid recipients said Thursday they worry about people slipping through the cracks and new administrative burdens being added to the state.
Fedorchak, a Republican member of the House Energy and Commerce Committee, voted in favor of reforms to Medicaid during a meeting that ended Wednesday.
During a virtual press conference Thursday, Fedorchak said the overhaul will ensure the program remains solvent for people with disabilities, pregnant women and elderly people for whom it was designed.
“In my opinion, I don’t think this will result in fewer people receiving those benefits,” Fedorchak said. “It will result in the people who qualify for them receiving them.”
According to the Congressional Budget Office analysis, which was shared with States Newsroom, about 10.3 million people would lose access to Medicaid or the Children’s Health Insurance Program, with 7.6 million people becoming uninsured during the 10-year budget window.
Those receiving Medicaid benefits would need to submit to eligibility requirements twice per year. In addition, people without disabilities between ages 19 to 64 would be required to work, volunteer or attend school for 20 hours per week to retain their benefits, she said.
“This is a very important and humane requirement,” she said. “We want to help people become independent … this program should help encourage and incentivize able-bodied people to find a job, or be engaged with the community.”
The Medicaid work requirements will not apply to pregnant women, foster youth under age 26 and tribal members, Fedorchak said. Those considered “medically frail,” which include people who are blind or disabled, those with a substance-use disorder, or serious or complex medical conditions, would also be exempted from the work requirements.
The exemptions also extend to the parent, or caregiver, of a dependent child, those who are incarcerated or released from incarceration within 90 days, those impacted by natural disasters, or people living in counties with an unemployment rate greater than 8%, or an unemployment rate 150% higher than the national average.
“There’s a lot of very reasonable, I think, and appropriate exemptions included in this for folks who might not be able to reasonably meet these requirements,” she said.
Kirsten Dvorak, executive director of The Arc of North Dakota, an organization that promotes the rights of people with intellectual and developmental disabilities, said she worries about people “falling through the cracks” because of the additional Medicaid requirements. She added she finds the inclusion of “able-bodied” in the bill text concerning.
“How do you define able-bodied?” Dvorak said. “Our disability community, through whatever means, is being attacked right now. And our community is nervous.”
Dvorak said many people with disabilities work in North Dakota communities, in some cases due to job coaching services that are funded through Medicaid.
She also questioned who was going to do the additional paperwork for the people with disabilities to continue receiving their services. Some members of the disabled community are under corporate guardianships because they don’t have anybody who can make decisions for them, she said.
About 108,000 North Dakota residents are eligible to receive Medicaid benefits as of April, including more than 54,000 people under age 21, according to data from the North Dakota Department of Health and Human Services.
LuWanna Lawrence, a spokesperson for HHS, said the department is in contact with Fedorchak and North Dakota’s congressional delegation about what the proposed legislation would mean to the state.
“We are closely monitoring the budget process at the federal level. At this time, we cannot speculate on potential impacts,” Lawrence said in a statement.
Verifying the work requirements and additional Medicaid eligibility requirements is likely to require more state workers to process the paperwork, said State Senate Minority Leader Kathy Hogan, D-Fargo, a member of the Senate Human Services Committee.
Hogan said she would not be surprised if state health officials approach the Legislature during the interim to request additional funding and staffing.
On the proposed work requirements, Hogan said many people receiving Medicaid benefits work in low-paying service jobs that do not offer health insurance. She questioned what would happen if a person worked 18 hours one week and 22 hours the next.
“Do you lose your benefit? It’s really complicated to document, particularly for lower-end workers,” she said. “The ability to actually implement these administrative responsibilities feels like a punishment for being poor.”
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