By Whitney Tucker, research director
From 1999-2016, opioid-related overdose fatalities increased by more than 800 percent in North Carolina, resulting in more than 12,000 preventable deaths statewide and a marked increase in the number of children heading into the state’s foster care system. A new report from NC Child explores key elements of the growing crisis of substance misuse by parents on North Carolina’s child welfare system. For working families who cannot afford private health insurance, but earn too much to qualify for Medicaid, closing the health insurance coverage gap is a promising policy to protect children and keep North Carolina’s families together.
Children of parents with a substance use disorder suffer from a wide range of harmful impacts, including increased risk of substance misuse in adulthood. They are also at significantly higher risk of abuse or neglect and subsequent entry into foster care. During 2017, more than 16,500 children in North Carolina lived in foster care. Parental substance misuse was a factor in out-of-home placement for at least 39 percent of children entering foster care in the 2016-17 fiscal year, up from 26 percent in 2007-08. 
Because of the high cost of treatment for substance use disorder, many parents who want to get treatment and reunite their families are unable to. Medicaid can be a lifeline for lower-income families. Medicaid covers detox, medication-assisted treatment (MAT), outpatient counseling, and other evidence-based treatment and recovery supports. For thousands of families who earn too much to qualify for Medicaid, but too little to purchase private health insurance, such treatments are too often far beyond reach, increasing the risk of overdose death, and prolonging children’s stays in foster care.
Nationally, closing the health insurance coverage gap is estimated to have reduced the unmet need for substance use treatment by as much as 18 percent. States battling the opioid epidemic, including Kentucky, West Virginia, Iowa, New York, and Washington, have found that expanded eligibility for Medicaid coverage is dramatically increasing access to substance use treatment services.
North Carolina is currently considering a proposal that would create an affordable insurance option and close the coverage gap. The bill, HB662, sponsored by Rep. Donny Lambeth (R-Forsyth), would create the Carolina Cares program, which would use federal funds to expand care to low-income working families who currently earn too much to qualify for Medicaid. By passing HB662, the North Carolina General Assembly could provide many parents with the insurance they need to access life-saving treatment and prevention services.
Unfortunately, there is a catch. One of the shortcomings of HB662 is the inclusion of work requirements for beneficiaries, which could prevent individuals struggling with substance use disorders from accessing needed care. While the Carolina Cares proposal includes an exception from work requirements for individuals who are currently receiving treatment for substance use, it fails to acknowledge the long-term and variable nature of successful substance use treatment and recovery. The recovery process can involve multiple episodes of treatment, but someone who leaves treatment under Carolina Cares would no longer qualify for the exemption. The work requirement therefore jeopardizes recovery for individuals who have completed treatment, but may still need recovery supports.
Families are stronger when parents have the tools they need to properly care for their children. Lawmakers should act now to shield kids from the negative impacts of parental substance misuse by ensuring all North Carolinians who need treatment for these conditions are able to receive it. Closing the health insurance coverage gap is an evidence-based policy solution that can help our state address the rising number of children in foster care as a result of the opioid crisis.
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