RALEIGH, N.C. — Gov. Josh Stein is warning that federal Medicaid cuts coming to North Carolina will raise costs for everyone in the state, from Raleigh, N.C., to its rural hospital towns, not just the people who lose coverage, and he is urging Congress to reverse them.
In a column published Oct. 11, Stein said more than 740,000 North Carolina adults gained health coverage through Medicaid expansion, which the state adopted in 2023. He said the federal law known as H.R. 1 cut the Medicaid program by $1 trillion and added layers of paperwork, and that more than 250,000 North Carolinians could lose coverage as a result.
Stein argued that when people go uninsured, hospitals absorb more unpaid care, families pile up medical debt and the cost shifts to taxpayers and private insurance customers through higher premiums. He said rural hospitals in North Carolina alone are projected to lose $3.7 billion over 10 years, and he called a new federal rural health fund of about $1 billion over five years far too small to fill the gap.
The governor also pointed to the lapse of Affordable Care Act tax credits, saying 214,000 fewer North Carolinians enrolled in 2026, the biggest drop of any state, and to SNAP cuts that could cost as many as 90,000 residents their food assistance.
The biggest change for enrollees starts Jan. 1, 2027. Under the new rules posted by NC Medicaid, most adults ages 19 through 64 will need to work, go to school, volunteer or make a certain amount of money each month to keep their coverage. They can meet the rule by earning at least $580 a month or by logging 80 hours of approved activities, about 20 hours a week. Those adults will also renew every 6 months instead of once a year.
Parents and caregivers of a child under age 14, people who are pregnant and people with a disability are among the groups that may be exempt.
Stein urged Medicaid members to open and read notices from NC Medicaid and their county Department of Social Services, keep records that prove eligibility and use the state Know What’s Next toolkit to see whether the new rules apply to them.
