How the GOP's proposed federal Medicaid cuts would impact N.C.

Axios

13-05-2025

Millions of Americans could lose health care coverage under a long-awaited proposal unveiled Sunday night by U.S. House Republicans that would slash $880 billion in federal Medicaid spending.
Why it matters: States have been bracing for details on how exactly House Republicans would slash Medicaid funding, with North Carolina estimating that in the worst-case scenario, the state could lose out on some $27 billion in federal Medicaid funds over the span of 10 years.
North Carolina's worst fears for how Republicans could cut Medicaid were not realized.
Still, under the proposal, the state could have to spend more on Medicaid or cut benefits for some of the 2.9 million residents covered under the program.
Driving the news: The new proposal, which aims to slash federal spending to fund Republicans' desired tax cuts, would implement work requirements for non-pregnant Medicaid recipients ages 19-64.
It's a way to reduce benefits without outright eliminating them, Axios' Emily Peck writes.
The proposal would also increase the frequency of checks on Medicaid eligibility — to every six months rather than annually — and would restrict Medicaid funding for abortion providers.
The big picture: Should the proposal become law, an estimated 8.6 million people nationwide would lose health care coverage by 2034, per the Congressional Budget Office.
Zoom in: The legislation would also ban new or increased provider taxes, effectively freezing the taxes at current rates, Axios' Peter Sullivan and Victoria Knight report, which could squeeze state budgets.
North Carolina uses provider taxes to pay for 26% — or $2.5 billion — of its Medicaid program.
Yes, but: North Carolina was bracing for either a possible per-capita cap on the money states receive for each enrollee or a reduction of contribution amounts to states that have expanded Medicaid.
Both of those changes could have upended the state's Medicaid program and led to drastic cuts.
Threat level: It's not yet known how many North Carolinians the proposal could affect; states are scrambling to analyze their respective impacts.
"The proposals, including work requirements and increasing frequency of redeterminations will increase the overall cost for state and federal governments while creating additional barriers for people to access critical care," North Carolina's Department of Health and Human Services.
"Additionally, people who are eligible for Medicaid could lose coverage due to administrative hurdles."