BISMARCK, N.D. – This weekend marks the 52nd anniversary of the Medicaid program, signed into law by President Lyndon Johnson on July 30, 1965.

Medicaid provides insurance for children, pregnant women, people with disabilities, seniors and low-income adults, and 114,000 North Dakotans currently are enrolled in the program.

Amy Thom is a social worker whose daughter Emory suffers from epilepsy due to a rare disorder called Sturge-Weber Syndrome. Emory has undergone numerous therapies and receives therapy in school thanks to Medicaid. Thom says she and her husband also get in-home services for her daughter.

"We aren't able to just leave her with a typical babysitter and maybe go out to supper one night, or even to just run out and do a couple errands,” she points out. “And so, Medicaid has helped that piece. We have the in-home supports that we can hire respite to come in an hour or two here or there."

Thom notes that both she and her husband are insured and use Medicaid as supplemental coverage for Emory. She says her family would pay about $11,000 out-of-pocket each year without it.

Friday at noon, speakers will be on the Burleigh County Courthouse lawn in Bismarck, celebrating the anniversary of Medicaid's signing.

The Trump administration and the U.S. House have proposed massive cuts to the program to bring down the federal deficit. Along with changes to the Affordable Care Act in the American Health Care Act, the House budget would slash $1.5 trillion from Medicaid over the next decade.

Mike Chaussee, associate state director for advocacy at AARP North Dakota, says an unlikely alliance has formed to oppose cuts.

"It's not always that the health care industry and the consumer advocates are fighting for something together,” he states. “And in this fight, we all agree on how important it is to save Medicaid."

Chaussee says the program has been especially helpful for seniors who aren't able to fully cover nursing or in-home costs through Medicare. He calls the program a "lifeline" for many seniors.

Thom says she wants to advocate for the people who can't advocate for themselves.

"I think it's incredibly important because it's people's lives, and it affects the quality that they're able to have, and there's amazing services out there," she stresses.





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Missouri's Department of Social Services anticipates as many as 200,000 Missourians will lose their Medicaid benefits over the course of the next year, because their income has increased and they no longer qualify.

While the public health emergency was in effect, states could not remove anyone from their Medicaid rolls, but as the Medicaid "unwinding" has begun, the department is resuming annual renewals.

Kim Evans, director of the family support division for the Department of Social Services, encouraged everyone to be sure the state has their current contact information so they don't miss important forms and requests for information. They can do it in a number of ways.

"Individuals can go online and report that, at mydss.mo.gov, they can fax that to us, they can scan it to us," Evans outlined. "On our website we have a live chat, and somebody can report it to us that way also."

Evans pointed out there is also a resource center in every county for those who would like help in person. She explained the renewals will be processed the month the person originally qualified, beginning with June. The first round of annual renewal forms will be sent out the first week of May and must be returned by June 30.

Evans noted two circumstances will cause a person to receive a form.

"If we cannot verify the person's information, or the information we receive makes them totally ineligible for Medicaid, we will send an annual renewal form," Evans pointed out.

She stressed if people do not return their form on time, they risk a break in coverage. After the due date, they have 90 days to submit their information to have their case reopened.

Evans added the state is opening a new customer portal in early May, where all future forms and notices will be placed. She encouraged everyone to sign up once it is available.

"So they will be able to access this form that they'll be able to review, make changes," Evans explained. "Then they can submit that directly to the agency. That is really how we want everybody to complete their forms, because that populates the system."

Those who no longer qualify for Medicaid will be referred to the Marketplace to look for an insurance plan that works for them.


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House lawmakers have approved a bill to make it harder for low income Iowans to qualify for public assistance, and critics said the measure would hurt families who are already struggling to make ends meet.

Known around the Iowa Statehouse as the SNAP bill, Senate file 494 would have the state look into how many assets someone has before allowing them to qualify for public assistance, and would also require recipients to make more money than they currently do to be able to get those benefits, including Medicaid.

Rep. Heather Matson, D-Ankeny, said while designed to increase accountability, the bill is actually creating more barriers for Iowans who are already struggling, and would have an especially damaging effect on youth.

"Especially in really tough economic times when people are already struggling," Matson pointed out. "When we look at the rising costs that people are facing and the fact that food pantry use is at record highs, we know a lot of Iowans are struggling, kids should not get kicked off of getting access to food."

Advocates for low income Iowans are holding a public hearing on the measure today to take input from people who need those benefits, and put faces on the people who are using them.

Matson noted Iowa will invest about $8 million to implement the asset investigation program, which is the same amount the state stands to save if the bill becomes law. Because there is no economic benefit to the state, she calls the bill politically motivated and designed to create the impression lawmakers are fighting fraud and increasing accountability on behalf of taxpayers.

She added the bill would have unintended consequences if it becomes law.

"If you kick somebody off of Medicaid, that is their health insurance," Matson explained. "If things get really bad, they are going to go to the emergency room where we know emergency care is way more expensive than preventive care. If kids are hungry, and they are not able to get food, then do you think that they're going to be able to focus in school? No, they won't."

The bill would also create a new verification system for benefit recipients and require them to appeal to the state within 10 days if they are removed from the public assistance rolls.

By Sonali Kolhatkar for Yes! Media.
Broadcast version by Lily Böhlke for New York News Connection reporting for the YES! Media-Public News Service Collaboration

Maureen Gardner is proud of her 5-month-old son Garrett, who she says can already identify the color red and is growing so fast that he fits into clothes for a 1-year-old. Last July in New York City, a month before Garrett was born, Gardner began receiving $1,000 in cash monthly from The Bridge Project as part of a guaranteed income program intended to reduce poverty among women of color in the city.

"This was really a godsend for me," she says from her apartment in Harlem, speaking in hushed tones while Garrett naps.

Guaranteed income projects are distinct from presidential candidate Andrew Yang's idea of a universal basic income, which is premised on cash payments to everyone, not just the most vulnerable. A prominent example of a guaranteed income project is the Stockton Economic Empowerment Demonstration, which put $500 a month into the hands of 125 low-income residents of Stockton, California, for 24 months. Data gathered from the SEED project found that the cash significantly helped recipients stabilize their finances, acquire jobs, and improve their mental health, compared with a control group.

Can Guaranteed Incomes Benefit Low-Income Women and Children of Color?

Buoyed by the success of the Stockton experiment, guaranteed income projects, like the one Gardner is part of, are cropping up in major cities around the country. With the understanding that systemic economic racism results in disproportionate poverty within Black, Brown, and Indigenous communities, many projects are specifically targeting low-income people of color, and primarily women and mothers.

Megha Agarwal, the executive director of The Bridge Project and of The Monarch Foundation, which funds the program, explains that it "was formed out of our desire to support the babies and mothers in New York and beyond who are suffering devastating effects from poverty." According to Agarwal, of the 100 mothers currently enrolled in the program, 74% identify as Hispanic or Latino, and 40% identify as Black; 20% are undocumented. "Guaranteed income has long been on the list of demands to receive racial and economic liberation," she says.

A similar program, run by the Georgia Resilience and Opportunity Fund, also focuses on women of color-specifically Black women-in Atlanta. Hope Wollensack, the executive director of the GRO Fund and co-director of the In Her Hands Guaranteed Income Initiative based in Atlanta's Old 4th Ward, says it is "the largest program focusing on Black women in the country."

"Centering Black women is really important," Wollensack explains, because "they are one of the groups experiencing the most acute and sharpest impacts of economic insecurity that exists."

"He's already very smart," says Gardner of her son Garrett, beaming with pride. "I'm thinking, like, 'Let's buy some flash cards, let's buy sensory toys.'" Now that she has a modest but steady flow of cash, Gardner has the freedom and means to focus on her son's development-something that may be an unaffordable luxury for children born into low-income households.

"I do think that his brain development is higher than those who might not have access to the funds to be able to buy things for their children," says Gardner.

Underscoring the importance of such monthly payments, neuroscientists recently concluded in a study published in the Proceedings of the National Academy of Sciences that cash aid to low-income mothers improves the cognitive functioning of their newborn babies. Agarwal, whose program gives exclusively to mothers, says The Bridge Project is premised on the fact that "the first 1,000 days of a child's life are really a crucial period of development physically, mentally, and cognitively."

The Dignity Afforded by Money With No Strings Attached

Aside from helping to foster the cognitive development of newborns, cash aid to mothers affords them basic necessities. When Gardner was about to have her baby, she realized that something as simple as doing laundry was going to be a problem. Although her apartment building has a common laundry room for residents, it presented a serious challenge for a mother living alone with a newborn during a pandemic. "My thoughts were like, 'I can't go to the laundry room with my baby,'" she explains. "I can wear a mask, but my baby doesn't even have shots. I have no help with him. It's just me."

It was a conundrum that neither she nor a caseworker at a welfare office were likely to have anticipated until the need arose. But with discretionary cash on hand, Gardner had the freedom to solve her problem when it cropped up without having to prove her need to an aid officer, fill out paperwork, or track receipts. She simply purchased a compact $500 washing machine for her apartment so she and her newborn could remain safe. "Buying the washing machine had me feeling a sense of relief," she says.

For Agarwal, it is crucial that such projects guarantee incomes "with dignity, respect, and trust. That's something that you don't see with a lot of our welfare system right now."

Wollensack agrees that giving cash without any requirements is critical, saying, "We really think it's important that folks have the choice and agency to make decisions about their lives and what they need."

Existing government welfare programs-increasingly dubbed "entitlement programs" by conservatives seeking to cast them in a negative light-whether at a local, state, or federal level, require onerous amounts of paperwork to prove recipients are deserving of aid. Those receiving food stamps can only spend them on specific items. Additionally, many programs now have work requirements and may require drug testing. Guaranteed income projects, in contrast, impose no requirements on how the money can be spent and no judgments on what recipients choose to spend on.

"In the United States, we've been trained to believe that the only reason people are on welfare is because there's something wrong with their character," says Agarwal. "That's just not true."

According to Sarah Moran, the U.S. country director at GiveDirectly, which funds the In Her Hands program in Atlanta, "We don't trust people who are living in poverty in the United States. That is the way our social safety net is built, and we're trying to flip the script on that."

Gardner concurs, referring to her own experience: "It's a great feeling to feel freedom in the way that I spend it."

Can the Government Guarantee Incomes?

"While we're excited about the scope and scale of this project, we know it's not enough," says Wollensack of the Atlanta-based In Her Hands project. The guaranteed income projects in Atlanta, New York, and Stockton are all privately funded experiments aimed at generating real-world data for social scientists to analyze and at informing broader government-funded programs in the future.

In the last years of his life, Dr. Martin Luther King Jr. became a proponent of the idea that the government ought to ensure all people had access to a basic income. In his 1967 speech Where Do We Go From Here, he said, "We must develop progress, or rather, a program ... that will drive the nation to a guaranteed annual income." Dr. King added, "The dignity of the individual will flourish when the decisions concerning his life are in his own hands, when he has the assurance that his income is stable and certain."

Now, the city of Los Angeles has launched the nation's largest government-funded guaranteed income pilot project, giving $1,000 a month to 3,000 families for a year. The Basic Income Guaranteed: Los Angeles Economic Assistance Pilot, whose acronym is fittingly BIG:LEAP, accepted applicants in 2021 whose household income fell below the poverty line and is slated to begin payments soon. The cash will not replace existing government assistance but will instead supplement it.

Chicago is planning a similarly sized project with a larger pool of people receiving smaller monthly payments. And momentum is building for publicly funded programs in cities across the country as leaders organize under the network Mayors for a Guaranteed Income.

The closest the federal government recently came to a guaranteed income project was the monthly child tax credit program that sent payments to low-income parents as part of the American Rescue Plan Act of 2021. But amid claims that such payments could disincentivize employment, Congress chose to let that program expire in 2022.

Do Cash Transfers Work?

Wollensack dismisses the naysayers, saying, "If $850 a month is compelling enough against labor market wages that people are no longer incentivized to work, I think that's more of an indictment on [how] current wages [compare] to the cost of living than it is about our program."

Moran says, "Empirically, there is just no evidence that cash transfer programs discourage work." According to her organization's website, GiveDirectly "is currently running the largest universal basic income experiment in history," and has "conducted more than 10 randomized control trials."

In addition to labor concerns, critics of government aid say it causes inflation. "If large swaths of Americans have to live in poverty so that inflation stays below 2%, then something fundamentally about our economy isn't working," contends Wollensack.

Over the brief six-month duration of the child tax credit program, the modest monthly payments of a few hundred dollars cut child poverty by almost 30%. According to the Center on Budget and Policy Priorities, more than 90% of low-income families receiving the payments used the money "for the most basic household expenses-food, clothing, shelter, and utilities-or education."

"Our national social safety net is predicated on the idea that poverty is a personal choice and not structural or a policy choice," says Moran.

In reality, Agarwal says the choice to maintain poverty is an external one-made by our government. Through the child tax credit, "We were able to alleviate poverty at massive scales." In letting the program expire, she adds, "We've said it's OK to let those people fall back into poverty."

For women like Gardner, a modest amount of available cash is making a world of difference. "I don't know what I would be doing if I didn't have it," she says.

Sonali Kolhatkar wrote this article for YES! Magazine.


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