Gov.-elect Josh Stein addresses supporters in Raleigh on Nov. 5, 2024. (Photo: Galen Bacharier/NC Newsline)
Gov. Josh Stein sent congressional leaders a letter asking them to spare Medicaid from budget cuts. About 3.1 million North Carolinians use the government health insurance.
The U.S. House is considering Medicaid cuts that could reach $880 billion over 10 years. North Carolina Medicaid Director Jay Ludlam told legislators last week a cut of that magnitude would mean a possible loss to North Carolina of $27 billion over 10 years.
Children in North Carolina’s rural counties are more likely to rely on Medicaid than their urban counterparts, according to a recent report.
Rural adults are more likely to rely on expanded Medicaid than adults living in urban areas, according to DHHS data. Rural adults ages 18-64 are about 19% of the state’s population, but make up more than 36% of the people enrolled in expanded Medicaid. The state launched Medicaid expansion in December 2023, which allowed more low-income adults to enroll.
Stein touched on these issues in his letter to Congressional leaders.
“Medicaid serves a central role in North Carolina’s health care system, with more than 640,000 people newly enrolled under Medicaid expansion,” he wrote.
“Rural counties disproportionately benefit from Medicaid, with 29 mostly rural counties enrolling 40% or more of their population in Medicaid. Cuts to Medicaid would severely harm these areas, where access to care is already limited. Medicaid expansion has been instrumental in reducing uncompensated care and stabilizing the finances of rural hospitals, enabling them to continue to serve their communities. Medicaid also supports nursing homes and long-term care facilities, helping to cover nursing care, personal care, rehabilitation, medications, and medical supplies.”
The federal government pays for 90% of the cost of people using Medicaid under expansion. Most of the rest is covered by an assessment on hospitals.
The 2023 law expanding Medicaid in the state says it will end if the federal government stops covering 90% of the cost.
“Lowering the enhanced federal match for Medicaid expansion would end Medicaid expansion in North Carolina after a hard-fought bipartisan bill finally implemented the program in December of 2023,” Stein wrote. “More than 640,000 North Carolinians would immediately lose their health care coverage and providers would lose $6 billion in federal funds. The damage to North Carolina’s health care system, particularly rural hospitals and providers, would be devastating, not to mention to people who can no longer afford to access health care.”
U.S. House committees were told to hit budget targets, but Republicans have not voted on any cuts. The House and Senate would need to agree on a budget before it goes to President Donald Trump. No agreement is expected for months.
Though state legislators have not said how they would handle Medicaid cuts, Rep. Donny Lambeth (R-Forsyth), senior chairman of the House budget committee, and leaders of the chamber’s Health and Human Services budget committee filed a bill last month that would create a committee to consider ways to cut the state’s Medicaid program in response to federal budget cuts.
Republicans in Congress are looking for budget cuts to pay for the tax cuts and immigrant deportation plans that top Trump’s domestic agenda.