Medicaid Expansion Is on the Line

Starting January 1, 2026, the federal government will cut the extra funding that helped North Carolina expand Medicaid. That means our state will have to cover more costs — and the 2023 expansion that brought care to over 600,000 people is at risk.

A built-in “trigger law” will end expansion entirely if federal support drops below 90%. With these cuts coming, that’s a real possibility.

To prepare, the state has already cut provider payment rates — making it harder for people, especially those with complex needs like autism, to find care.

51%

of NC Children are on Medicaid

4.15 mil

Necessary prescriptions at risk

650,000+

North Carolinians could lose coverage

$58 mil

in Dental Services at risk

Big Picture Impact

  • The law ends enhanced subsidies for the Affordable Care Act marketplace plans. That could mean significantly higher premiums for many North Carolinians in 2026.

  • The state budget stopped funding the “Healthy Opportunities Pilots” after June 30, 2025 — these were programs for addressing social-determinants of health (housing, nutrition, transportation). They’re paused now, even though the state hopes to restore funding.

New Work Requirements

  • A federal rule taking effect December 2026 will require many Medicaid expansion recipients to report 80 hours/month of “community engagement” (work, volunteering, schooling) to keep their coverage.

  • State Medicaid officials have warned: this will be complicated and costly to implement (tracking, verifying hours, managing exemptions).

Frequent Eligibility Checks and Gaps in Coverage

  • From December 31, 2026, Medicaid rules will require states to verify eligibility every six months instead of annually.

  • County social-services offices will need to double their workload, risking processing delays and even lapses in coverage for some of our neighbors.