{"id":263483,"date":"2025-09-29T09:42:17","date_gmt":"2025-09-29T09:42:17","guid":{"rendered":"https:\/\/www.europesays.com\/us\/263483\/"},"modified":"2025-09-29T09:42:17","modified_gmt":"2025-09-29T09:42:17","slug":"medicaid-standoff-could-put-health-care-for-many-north-carolinians-at-risk","status":"publish","type":"post","link":"https:\/\/www.europesays.com\/us\/263483\/","title":{"rendered":"Medicaid standoff could put health care for many North Carolinians at risk"},"content":{"rendered":"

By Jaymie Baxley\u00a0<\/strong><\/p>\n

Efforts to prevent cuts that could significantly lower reimbursement to providers for services for North Carolinians on Medicaid stalled last week amid a three-way standoff between the state\u2019s Senate, House of Representatives and governor.<\/p>\n

Lawmakers are at odds over dueling proposals to fully fund the state\u2019s Medicaid rebase, an annual budget adjustment that accounts for changes in the number of people enrolled in the government-run health insurance program, and the cost of providing their care.\u00a0<\/p>\n

In July, the General Assembly approved a stopgap \u201cmini budget\u201d<\/a> that fell $319 million short of the $819 million the N.C. Department of Health and Human Services had requested for the rebase. Devdutta Sangvai, secretary of the department, later warned legislative leaders<\/a> that NC DHHS would be forced to make \u201cpainful cuts\u201d with \u201cserious and far-reaching consequences\u201d to adjust for the shortfall.\u00a0<\/p>\n

Providers across the state say those cuts would leave them with little choice but to reduce the number of patients they serve in the Medicaid program, which covers the cost of care for 3.1 million North Carolinians<\/a>.\u00a0<\/p>\n

The cuts will take effect Wednesday unless the House and Senate reach an agreement or Gov. Josh Stein intervenes.\u00a0\u00a0<\/p>\n

Impasse on hospital funds<\/strong><\/p>\n

The showdown began on Sept. 22, when the Senate passed a bill that would fund the Medicaid rebase and avert the looming cuts.<\/p>\n

However, that bill also earmarked more than $103 million for the construction of a 500-bed children\u2019s hospital in Apex.<\/p>\n

Both chambers agreed to set aside $320 million in funding for the project, a collaboration between UNC Health and Duke Health, in the state\u2019s 2023 budget. But the funds must be re-approved for the 2025 budget.<\/p>\n

Members of the House now believe the money would be better spent on more pressing needs.<\/p>\n

During an impromptu news conference after his chamber\u2019s working session, Senate leader Phil Berger (R-Eden) defended the decision to tie funding for the hospital to the rebase. He also accused the House of reneging on the project.<\/p>\n

\u201cA deal is a deal, and they agreed to it,\u201d he said. \u201cThey need to live up to what the arrangement was. They need to agree to this bill, and then we\u2019ll go ahead and fund Medicaid.\u201d<\/p>\n

That didn\u2019t happen. Instead, the House on Sept. 23 unanimously voted in support of a substitute bill that would fund the rebase but removes funding for the hospital.<\/p>\n

\u201cAs time has moved on, the facts have changed. And so even if there was, you know, some sort of agreement that they feel like needed to be honored, the facts have substantially changed,\u201d House Speaker Destin Hall (R-Granite Falls) said, citing inflation. \u201cThey\u2019re not the same as they were back in 2023 because the value of $1 is not the same as to the Children\u2019s Hospital.\u201d<\/p>\n

\u201cWe have at least five children\u2019s hospitals in this state. We\u2019ve got three or four really big ones,\u201d he continued. \u201cObviously, if we felt like the children of this state were not getting health care, we would act. But the fact is, they are getting health care.\u201d<\/p>\n

\"MembersMembers of the NC House of Representatives on Sept. 23, 2025. Credit: Jaymie Baxley\/NC Health News<\/p>\n

Hall also talked about how the two chambers differed on a multiyear plan to lower taxes in North Carolina that has divided the two Republican-led arms of the General Assembly. The Senate wants to disregard state revenue triggers to push rates lower, while Hall is interested in a more cautious approach.\u00a0<\/p>\n

\u201cThe tax triggers no longer make sense,\u201d he said.<\/p>\n

Rep. Donny Lambeth (R-Winston-Salem) told NC Health News that the Medicaid funding bill approved by the House was \u201ccleaner\u201d than what the Senate had proposed.<\/p>\n

\u201cWe don\u2019t have a lot of things in it other than what we have to,\u201d said Lambeth, one of the chairs of the General Assembly\u2019s Joint Legislative Oversight Committee on Medicaid. \u201cThey want other things commingled in their bill, which we\u2019re not going to take up.\u201d<\/p>\n

The House\u2019s version of the bill has been sent to the Senate for a vote, but neither chamber is scheduled to meet again until Oct. 20 \u2014 weeks after the cuts take effect.<\/p>\n

\u2018This was their moment\u2019<\/strong><\/p>\n

Addressing a phalanx of TV cameras at Alliance Medical Ministry during a Sept. 25 news conference in Raleigh, Governor Stein, a Democrat, accused the state legislature of putting politics before people.<\/p>\n

\"Gov.Gov. Josh Stein stands at a podium in Alliance Medical Ministry talking to reporters about pending Medicaid rate cuts on Sept. 25, 2025. He is flanked by Pete Tannenbaum, executive director of Alliance Medical Ministry, and Jenna Beckham, an OB\/GYN from Wake County. Credit: Anne Blythe\/NC Health News<\/p>\n

\u201cThe General Assembly has failed you,\u201d he said. \u201cBut it is not too late for them to step up and do the right thing. I\u2019d hoped that the legislature would realize that helping people get the health care they need is more important than grinding their political axes.\u201d<\/p>\n

In interviews with NC Health News, Berger, Lambeth and other lawmakers contended that the cuts could be avoided, or at least postponed, without the legislature\u2019s involvement. They argued that NC DHHS has enough money and could use it to cover the shortfall while the House and Senate work to overcome their impasse once they return to Raleigh in earnest in early 2026 for their biennial \u201cshort\u201d session.<\/p>\n

\u201cMaking provider cuts is solely the choice of the department and how they choose to deal with budget surpluses or budget deficits, perceived or real,\u201d Sen. Ralph Hise (R-Spruce Pines) said.<\/p>\n

Rep. Donna McDowell White (R-Clayton) agreed, calling Wednesday\u2019s deadline a \u201cfalse date.\u201d<\/p>\n

\u201cMy constituents are very concerned about that, and what I\u2019m telling them is that the money\u2019s there,\u201d said White, a registered nurse who serves on the Medicaid oversight committee. \u201cOctober 1st should not even be on anybody\u2019s calendar.\u201d<\/p>\n

Stein, however, insisted that the department has already stretched its resources to delay the cuts as long as possible.<\/p>\n

He said NC DHHS had been cautioning about the possibility of rate cuts since May \u2014 \u201cin meetings, in emails, in-person briefings, letters, conversations and press conferences, over and over until we were blue in the face.\u201d<\/p>\n

\u201cWe put off the cuts for a full quarter of this fiscal year,\u201d Stein said. \u201cWe did not institute these cuts in July, in August or September because we knew they were coming back in September. We were as clear as a ringing bell that this was their moment to solve this problem, and we could put the cuts off till October.\u201d<\/p>\n

Further delaying the cuts, he said, will \u201cjust increase the pain.\u201d<\/p>\n

\u201cThe same amount of money is still going to be needed to address the shortfall,\u201d he said. \u201cThey\u2019ve had the opportunity to solve this repeatedly. This was their moment. We could not have been more clear; they had to solve this in September. They chose to put their political differences ahead of our people\u2019s health.\u201d<\/p>\n

Behind the scenes, officials from NC DHHS have proposed a solution that would allow lawmakers to buy more time.\u00a0<\/p>\n

In anticipation of a stalemate between the House and Senate, the department floated the idea of pulling funds from the state\u2019s Medicaid contingency reserve \u2014 a pool of money set aside to cover unexpected costs in the program \u2014 to legislative leaders last week.\u00a0<\/p>\n

Neither chamber has moved to pursue that option, although Lambeth said he wasn\u2019t opposed to it.<\/p>\n

\u201cWe have to be able to at least freeze the rates while we continue to work toward a longer-term solution,\u201d he said. \u201cWe need to do whatever we need to do, whether it\u2019s pulling from the contingency, which they could do, or the governor calling for a halt to the cuts while we continue to work through it.\u201d<\/p>\n

What\u2019s at stake<\/strong><\/p>\n

Josh Dobson, president and CEO of the North Carolina Healthcare Association<\/a>, said the cuts would be \u201cincredibly significant\u201d for the more than 130 hospitals and health care systems represented by his organization.<\/p>\n

Nearly every provider in the state would see the reimbursements they receive for treating Medicaid patients reduced by 3 percent to 8 percent. Some providers, including nursing homes, acute care hospitals and psychiatric residential treatment facilities, would have their rates slashed by 10 percent.<\/p>\n

Dobson said those decreases are likely to drive many providers \u2014 especially those in rural areas, where facilities often operate on thin margins and serve a higher share of Medicaid patients \u2014 to stop accepting Medicaid altogether. He worries that smaller, financially vulnerable\u00a0providers will be forced to close down completely.<\/p>\n

\u201cMy hope would be that the department would delay these cuts to allow time for more negotiations,\u201d Dobson said in a recent interview with NC Health News. \u201cIt was a surprise that the department would go so quickly to 10 percent cuts without more discussion.\u201d<\/p>\n

Wesley Wallace, a professor emeritus of emergency medicine at UNC Chapel Hill, fears the cuts will trigger a \u201cdownward spiral of health care\u201d across the state.\u00a0<\/p>\n

\u201cIf providers are not paid enough to provide care, if hospitals are not provided enough to pay their employees, they will close the doors or dramatically decrease their services,\u201d said Wallace, one of several people who spoke during a Sept. 22 event in front of the state legislative building while the state Senate met inside. \u201cIn the case of Medicaid, if the already low reimbursements are decreased more, they will simply quit accepting Medicaid patients.\u201d<\/p>\n

\"WesleyWesley Wallace, a professor emeritus of emergency medicine at UNC Chapel Hill, speaks during an event in front of the state legislature on Sept. 22, 2025. Credit: Taylor Knopf\/NC Health News<\/p>\n

His concerns were echoed by Jenna Beckham, an OB\/GYN in Wake County who spoke during the governor\u2019s news conference. She said the cuts could result in patients losing access to routine exams, prenatal care, cancer screenings and other essential services that she and others in her field provide.<\/p>\n

\u201cThis will lead to longer wait times, delayed diagnoses and worse health outcomes for the patients of our state, especially for those who live in rural communities and who are already marginalized and underserved,\u201d Beckham said. \u201cThe impact will be most severe for many patients who have complex medical needs, high-risk pregnancies and our most vulnerable children. Those who are already facing barriers to care will be hit the hardest.\u201d<\/p>\n

Other threats<\/strong><\/p>\n

The standoff between the House and Senate, and the governor\u2019s unwillingness at this point to put off the cuts past Wednesday, come as other significant health care funding changes loom.<\/p>\n

The One Big Beautiful Bill Act that President Donald Trump championed and signed in July calls for nearly $1 trillion in Medicaid cuts over the next decade, shifting more of the cost burden onto states. Those costs will be compounded by federal lawmakers\u2019 failure to renew key Affordable Care Act subsidies offered during the pandemic, leading insurance companies in North Carolina and elsewhere to seek approval for rate increases<\/a> that range from 6.9 percent to 36.5 percent.<\/p>\n

Meanwhile, a new federal rule<\/a> set to take effect in December 2026 will require Medicaid enrollees to prove they are working, attending school or volunteering for at least 80 hours a month.<\/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 reduces the amount of taxes the state can impose on providers \u2014 limiting the state\u2019s ability to offset the work requirement\u2019s cost.<\/p>\n

Ludlam said the combination of the work requirement and lower provider tax cap will likely undo the expansion of Medicaid that North Carolina lawmakers approved in 2023<\/a>.\u00a0<\/p>\n

Expansion increased the state\u2019s previously strict income threshold for Medicaid, raising it to $21,597 for an individual or $36,777 for a family of three. This opened up the program to many low-wage workers who did not receive coverage at their jobs, but nonetheless made too much money to qualify.\u00a0<\/p>\n

More than 680,000 people, or about 22 percent of the state\u2019s total Medicaid enrollment, had gained coverage through expansion as of Sept. 2, according to data from NC DHHS<\/a>.<\/p>\n

Ludlam said all of those enrollees are at risk of losing their benefits because of a financial \u201ctrigger\u201d that the General Assembly placed in the Access to Healthcare Options Act<\/a> \u2014 the law that expanded Medicaid. It includes a clause that discontinues expansion if the state is forced to pick up any costs.\u00a0<\/p>\n

The loss in provider taxes, Ludlam said, leaves the state with \u201cfew financial mechanisms to pay for\u201d expansion, let alone the cost of checking the employment status of expansion beneficiaries, effectively tripping the trigger<\/a>. Lawmakers will need to modify or get rid of the clause to protect expansion.<\/p>\n

\u201cBecause of the changes in the federal One Big Beautiful Bill, state legislators need to act and pass new legislation so that nearly 700,000 North Carolinians don\u2019t lose health care coverage or access to services,\u201d Ludlam said during a virtual \u201ctele-town hall<\/a>\u201d presentation on Sept. 24. \u201cAnd the change does not require more spending.\u201d<\/p>\n

Alliance Medical Ministry, the site of the governor\u2019s news conference, is a free and charitable clinic that provides care to working people who make too much to qualify for Medicaid but too little to afford private insurance.\u00a0<\/p>\n

In the coming months, Pete Tannenbaum, executive director of the ministry, expects to see an influx of newly uninsured patients.<\/p>\n

\u201cThe downstream financial impact of this crisis will hit clinics like ours and hospitals very hard,\u201d he told reporters. \u201cSome people with chronic diseases such as diabetes, hypertension and obesity might then decide to forgo routine care that had been more accessible and only seek medical attention when they\u2019re dangerously ill \u2014 decisions that can lead to more emergency room visits and treatment regimens that are far more expensive.\u201d<\/p>\n

\u201cThis is not just a financial crisis,\u201d he said. \u201cIt\u2019s a human crisis.\u201d\u00a0<\/p>\n

Anne Blythe, Rose Hoban and Taylor Knopf contributed to this story.\u00a0\u00a0<\/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\u00a0 Efforts to prevent cuts that could significantly lower reimbursement to providers for services for North…\n","protected":false},"author":3,"featured_media":263484,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[35],"tags":[7023,137685,210,1141,1142,137686,26253,39914,21918,21919,137687,9703,137688,137689,137690,137691,137692,4573,67,132,68],"class_list":{"0":"post-263483","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-health-care","8":"tag-affordable-care-act","9":"tag-gov-josh-stein","10":"tag-health","11":"tag-health-care","12":"tag-healthcare","13":"tag-house-speaker-destin-hall","14":"tag-medicaid-cuts","15":"tag-medicaid-expansion","16":"tag-nc-department-of-health-and-human-services","17":"tag-nc-general-assembly","18":"tag-north-carolina-health-care-association","19":"tag-one-big-beautiful-bill","20":"tag-provider-rates","21":"tag-rep-donna-white","22":"tag-rep-donny-lambeth","23":"tag-se-ralph-hise","24":"tag-sen-phil-berger","25":"tag-state-budget","26":"tag-united-states","27":"tag-unitedstates","28":"tag-us"},"share_on_mastodon":{"url":"https:\/\/pubeurope.com\/@us\/115286936536797073","error":""},"_links":{"self":[{"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/posts\/263483","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=263483"}],"version-history":[{"count":0,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/posts\/263483\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/media\/263484"}],"wp:attachment":[{"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/media?parent=263483"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/categories?post=263483"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/tags?post=263483"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}