North Carolina Medicaid patients face care access threat as funding
impasse continues
[September 26, 2025]
By GARY D. ROBERTSON
RALEIGH, N.C. (AP) — North Carolina Medicaid patients face a threat of
reduced access to services — before separate changes approved within
President Donald Trump's spending-reduction law are implemented — as an
impasse over state Medicaid funding extends further.
Democratic Gov. Josh Stein, whose administration oversees Medicaid for
3.1 million people in the ninth-largest state, confirmed Thursday that
starting next week the state program will lower reimbursement rates for
doctors, hospitals and other medical providers.
Stein said it wasn’t too late for the Republican-controlled legislature
to solve the problem, adding that the rate cuts can be reversed. If no
solution can be found soon, many doctors may decide to leave the
Medicaid program, leaving Medicaid enrollees in precarious positions, a
physician said at the news conference.
“This 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,” Dr.
Jenna Beckham said at a health care clinic in Raleigh.
Stein's administration has said for several weeks that additional
Medicaid funds approved by the General Assembly this summer were still
$319 million short of addressing population changes and rising health
care costs, and without a fix rate reductions would take effect Oct. 1.
GOP lawmakers couldn't agree on a way forward this week as the two
chambers failed to agree about spending on two health care projects.
With the legislature next scheduled to meet Oct. 20, Stein said the
state Medicaid agency couldn't delay further to avoid deeper future
reductions, and he blamed lawmakers in the process. The broad reductions
range from 3% for home health and ambulance services to 10% for
hospitals, nursing homes and hospice care.
“They put their political disputes ahead of our people’s health,” Stein
said at Alliance Medical Ministry. “Their disagreements have nothing to
do with Medicaid. It’s hard for me to express the gravity of their
failure.”
Republican lawmakers said such unilateral action by Stein was
unprecedented so early in the fiscal year, and insist the rate cuts —
which could prompt some providers to reduce services or stop seeing
Medicaid enrollees — aren't needed.
“The governor has decided with very little notice to threaten not us but
the North Carolina residents needing health care with massive cuts that
will begin months before they have to,” GOP Rep. Grant Campbell of
Cabarrus County, a physician, said on the House floor this week.
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North Carolina Gov. Josh Stein speaks while Chelsea Gray of
Rutherfordton, N.C., left, and Dr. Jenna Beckham, right, listen at a
news conference about Medicaid reimbursement rate reductions at the
Alliance Medical Ministry in Raleigh, N.C., on Thursday, Sept. 25,
2025 (AP Photo/Gary D. Robertson)
 Stein and Jay Ludlum, a deputy
health secretary who leads North Carolina Medicaid, said Thursday
that unlike recent years no additional federal funds are anticipated
to close the shortfall.
House and Senate Republicans this week offered and passed competing
bills that increased Medicaid funding another $190 million annually
— an amount that Stein said the agency could accept until early
2026. But legislators left Raleigh without a final measure,
deepening animosity while a state government budget is also three
months late.
The Senate bill included language that also directed $208.5 million
in previously received federal money be allocated to help build a
standalone children's hospital in Wake County by two university
medical schools and for rural health investments. The House version
left them out.
Senate Republicans said they and House counterparts had agreed in
2023 to authorize funding for the hospital and rural health
initiatives, and project leaders are counting on what is now a third
portion of funds, Senate Majority Leader Michael Lee told
colleagues. But House Republicans now have second thoughts about
both projects and said they should be discussed within broader
budget negotiations.
House Speaker Destin Hall said there are already several children's
hospitals in the state and some colleagues have asked, “Why would we
give hundreds of millions of dollars to a new hospital in Wake
County that’s doing pretty good economically?” Senate leader Phil
Berger said the House is to blame for threatening Medicaid services
because they aren't sticking to its previous decisions on the
hospital and rural health care projects.
Stein and his Democratic allies have said Trump’s spending-cut law
he signed in July threatens Medicaid enrollment for hundreds of
thousands of residents and the health of rural hospitals. While
Republican lawmakers have downplayed the threat, diminishing funds
from Washington have placed them in a more cautious fiscal posture.
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