{"id":201862,"date":"2025-09-05T08:45:13","date_gmt":"2025-09-05T08:45:13","guid":{"rendered":"https:\/\/www.europesays.com\/us\/201862\/"},"modified":"2025-09-05T08:45:13","modified_gmt":"2025-09-05T08:45:13","slug":"medicaid-cuts-threaten-care-for-nc-residents-with-severe-disabilities","status":"publish","type":"post","link":"https:\/\/www.europesays.com\/us\/201862\/","title":{"rendered":"Medicaid cuts threaten care for NC residents with severe disabilities"},"content":{"rendered":"

By Jaymie Baxley<\/strong><\/p>\n

Jennifer Shigley can\u2019t speak or walk without assistance.<\/p>\n

The 49-year-old also cannot feed or bathe herself. Her father, a retired child psychologist, described her as having the mental capacity of a toddler.<\/p>\n

\u201cShe requires total care,\u201d Hal Shigley said. \u201cThank goodness she is in a facility where she\u2019s taken good care of.\u201d<\/p>\n

For eight years, Jennifer has lived at a group home operated by the Raleigh nonprofit TLC<\/a> \u2014 formerly known as the Tammy Lynn Center \u2014 for adults with intellectual and developmental disabilities. Like other residents of the facility, her around-the-clock care is made possible by North Carolina\u2019s Medicaid program.<\/p>\n

\u201cIt\u2019s very expensive to care for people like Jennifer and people who have similar disabilities,\u201d said Hal Shigley, who estimated that the government-funded health insurance program pays \u201csomewhere in the neighborhood\u201d of $150,000 a year for his daughter to stay at TLC.<\/p>\n

Jennifer\u2019s benefits shouldn\u2019t be affected by looming federal cuts<\/a> to Medicaid because she\u2019s in a special coverage category for people with profound intellectual and developmental disabilities.\u00a0<\/p>\n

But advocates are warning that the Trump administration\u2019s proposals to slash Medicaid \u2014 a program where states and the federal government each shoulder part of the costs \u2014 by up to $2.3 trillion over the next decade could end up jeopardizing the kind of care she receives.<\/p>\n

Strain on the system<\/strong><\/p>\n

Sarah Crawford, a Democratic member of the N.C. House of Representatives, has a stake in the issue: She\u2019s CEO of TLC.<\/p>\n

Crawford said the 30 adults who live at the organization\u2019s three group homes for people with \u201csevere and profound needs\u201d require 24-hour personal care, with \u201c99 percent of their medical treatment\u201d provided on site. The average annual cost of that care, she said, is about $230,000 per person.<\/p>\n

Without Medicaid, Crawford said it would be \u201cnearly impossible for the majority of families to pick up the tab.\u201d<\/p>\n

\u201cThese are families that rely on TLC,\u201d she said. \u201cThere are folks that have lived with us for 30 years. This is their home. This is where they live and live life to the fullest.\u201d<\/p>\n

The Trump administration has not proposed eliminating or limiting Medicaid benefits for participants with intellectual or developmental disabilities. People with disabilities are among the few groups exempt from a new rule<\/a>, set to take effect in December 2026, that requires enrollees to prove they are working, attending school or volunteering for at least 80 hours a month.<\/p>\n

But Crawford fears the work requirement<\/a> and other sweeping changes laid out in the One Big Beautiful Bill Act signed into law on July 4 will nonetheless have downstream implications for organizations like TLC.<\/p>\n

\"SarahSarah Crawford, CEO of Raleigh nonprofit TLC, has served in the N.C. House of Representatives since 2023.
\n Credit: Kelly Hudgins\/Light Creative<\/p>\n

Jay Ludlam, head of Medicaid for North Carolina, has said that implementing the work requirement will force the state to develop a costly, complex new platform to check beneficiaries\u2019 employment status.<\/p>\n

The OBBBA does not provide the state with any federal funding to create that platform. In fact, it limits North Carolina\u2019s ability to offset the work requirement\u2019s cost because the new law reduces the amount of taxes the state can impose on providers.\u00a0<\/p>\n

North Carolina currently collects a 6 percent tax on providers\u2019 net revenue from patients. The new law lowers the rate to 3.5 percent. Having that lower tax rate means that the state cannot\u00a0 draw down as much federal matching money for Medicaid.<\/p>\n

Medicaid is such a large program that even a change of 1 percent can end up equating to hundreds of millions of dollars. Ludlam said the provider tax rate cap will likely result in billions of dollars in lost funding for the state.<\/p>\n

Crawford said those reductions could leave facilities like TLC struggling to stretch already thin resources. \u201cIf we lose funding, it will be harder for us to provide that care because we will have to do the same amount with less,\u201d she said.<\/p>\n

\u201cAs the Medicaid system gets stressed and strained because of less money being available in that pie, we are concerned about the impact to the services that we provide,\u201d she added. \u201cIf the systems get strained in a way that Medicaid can no longer fund those services, it would be very, very difficult for families to provide those services.\u201d<\/p>\n

A broader reckoning<\/strong><\/p>\n

Corye Dunn, director of public policy for Disability Rights North Carolina<\/a>, said it would be a mistake to assume the cuts won\u2019t touch people with disabilities just because their coverage isn\u2019t in the crosshairs.<\/p>\n

\u201cThere is no way to make the massive cuts the federal government has made without hurting people with disabilities,\u201d Dunn said. \u201cWe are disproportionately reliant on Medicaid, even when we have private insurance because so many of the services people with disabilities need are not covered, traditionally, with private insurance.\u201d<\/p>\n

She worries that the cuts will result in rate reductions that would worsen North Carolina\u2019s shortage of direct support professionals<\/a> \u2014 the workers who feed, bathe and help residents with daily needs. Many already earn poverty-level wages, and turnover is rampant.<\/p>\n

\u201cAnytime there\u2019s a threat to rates, it\u2019s really a threat to staff salaries,\u201d Dunn said. \u201cPeople leave the field if they can\u2019t make enough money to live. You wind up with a less stable and overall lower-quality pool of staff available to people with disabilities when you threaten rates. That\u2019s just as true in a group home as it is in an intermediate care facility.\u201d<\/p>\n

Beyond staffing, Dunn said cuts could ripple across every part of a facility\u2019s operations, from food budgets to building upkeep.\u00a0<\/p>\n

\u201cRates affect everything,\u201d she said. \u201cThey affect how much we can staff, the quality of food that is served, the health and safety. There is not a single thing that rates don\u2019t impact, and we do not yet know how this will affect rates.\u201d<\/p>\n

Hal Shigley knows some lawmakers may balk at how much it costs to care for his daughter.<\/p>\n

\u201cWhen a politician hears that, they go, \u2018Whoa, there\u2019s something wrong with that picture,\u2019\u201d he said. \u201cI\u2019d like Jennifer to live with them for a week or two and let them do all the stuff necessary to keep her healthy and happy, and then we\u2019ll talk.\u201d<\/p>\n

He and his wife experience just how difficult it is to care for Jennifer when she visits their Swansboro home for a few days each summer and at Christmas.<\/p>\n

At 78, he no longer has the stamina or strength to manage her complex needs for long stretches without help.<\/p>\n

\u201cWe love having her here, but it is exhausting,\u201d he said. \u201cWe have to be really careful not to wreck our backs in the process of getting her up and down, bathing her and doing all the things necessary to care for her.\u201d<\/p>\n

\"WhileWhile residents of TLC aren\u2019t in danger of losing Medicaid, cuts to the program could jeopardize the care they receive. Credit: Kelly Hudgins\/Light Creative<\/p>\n

For Shigley, the idea of lawmakers scaling back Medicaid is more than a political debate \u2014 it feels like a moral test.<\/p>\n

\u201cI\u2019m a believer that a society is judged based on how it takes care of its weakest members, and it would be a bad commentary on the state of this nation if severely handicapped people didn\u2019t have a place to live,\u201d he said. \u201cThat would just be unconscionable.\u201d<\/p>\n

Reimbursement rate controversy <\/p>\n

The financial uncertainty surrounding Medicaid has been compounded by a plan recently announced by the N.C. Department of Health and Human Services to lower reimbursement rates for providers.\u00a0<\/p>\n

In an Aug. 11 letter<\/a> to state lawmakers, NC DHHS Sec. Dev Sangvai wrote that the agency would be forced to cut the rates paid to providers by as much as 10 percent. The cuts were necessary, he said, because of a $319 million funding shortfall in the stopgap \u201cmini budget<\/a>\u201d approved by the General Assembly in July.<\/p>\n

\u201cThese reductions carry serious and far-reaching consequences,\u201d Sangvai wrote. \u201cMost immediately, reduced rates and the elimination of services could drive providers out of the Medicaid program, threatening access to care for those who need it most.\u201d<\/p>\n

But lawmakers have reacted to this plan and aim to shut it down. As WRAL reported last week<\/a>, legislative leaders have ordered NC DHHS to postpone the cuts, which were expected to begin in October.<\/p>\n

Republish This Story<\/p>\n

\"Creative<\/a><\/p>\n

Republish our articles for free, online or in print, under a Creative Commons license.<\/p>\n","protected":false},"excerpt":{"rendered":"By Jaymie Baxley Jennifer Shigley can\u2019t speak or walk without assistance. The 49-year-old also cannot feed or bathe…\n","protected":false},"author":3,"featured_media":201863,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[35],"tags":[111538,210,1141,1142,7065,33957,111539,3170,26253,39915,21918,21919,39917,65221,111540,64485,67,132,68],"class_list":{"0":"post-201862","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-health-care","8":"tag-disability-rights-nc","9":"tag-health","10":"tag-health-care","11":"tag-healthcare","12":"tag-housing","13":"tag-idd","14":"tag-intellectual-and-developmental-disabilities","15":"tag-medicaid","16":"tag-medicaid-cuts","17":"tag-medicaid-work-requirements","18":"tag-nc-department-of-health-and-human-services","19":"tag-nc-general-assembly","20":"tag-provider-taxes","21":"tag-rep-sarah-crawford","22":"tag-tammy-lynn-center","23":"tag-tlc","24":"tag-united-states","25":"tag-unitedstates","26":"tag-us"},"share_on_mastodon":{"url":"https:\/\/pubeurope.com\/@us\/115150817046602942","error":""},"_links":{"self":[{"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/posts\/201862","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/comments?post=201862"}],"version-history":[{"count":0,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/posts\/201862\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/media\/201863"}],"wp:attachment":[{"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/media?parent=201862"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/categories?post=201862"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/tags?post=201862"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}