$1 Trillion Medicaid Cut Could Hit North Carolina Hard — 600K Residents at Risk

SALISBURY, North Carolina — A proposed $1 trillion Medicaid cut in the Republican-backed “One Big Beautiful Bill” is sending shockwaves through North Carolina, where the future of expanded Medicaid coverage — which now supports more than 600,000 people — hangs in the balance.

Lifeline at risk for working poor, disabled residents

For locals like Enid Rodriguez, Medicaid has been a lifesaver. After decades of working in child services and helping run a small business, she finally qualified for coverage in late 2023, when the state expanded eligibility. Medicaid allowed her to see specialists, receive physical therapy, and manage chronic conditions previously left untreated.

But all that could vanish if federal funding gets slashed. Rodriguez told reporters she fears being forced to give up the care that has helped stabilize her health. “We shouldn’t have to work fifty-, sixty-hour weeks to pay our bills and still struggle with medical expenses,” she said.

What the GOP bill proposes — and why it matters

According to a breakdown from the Congressional Budget Office, the proposed legislation could cut Medicaid by nearly $1 trillion over 10 years. Provisions include:

• Stricter work requirements,

• Reduced federal contributions to state Medicaid plans,

• Complex eligibility checks every 6 months (instead of annually).

Though supporters like former President Donald Trump claim the bill “leaves Medicaid the same,” the CBO estimates nearly 12 million Americans could lose coverage — with North Carolina hit especially hard due to a built-in clause in its expansion law.

Medicaid expansion may be automatically reversed

North Carolina’s 2023 bipartisan expansion law includes a trigger clause: if the federal government cuts its share or imposes new state costs, the program ends automatically. Health policy analysts warn the proposed Senate bill would likely activate this clause, leaving many in limbo.

Some Republicans, including Senator Thom Tillis, have raised concerns. Tillis recently announced he would vote against the bill, citing a potential $38.9 billion loss in Medicaid support for North Carolina. But critics argue even scaled-back cuts could lead to catastrophic outcomes.

Health providers brace for collapse

Rural clinics like Blue Ridge Health and CommWell Health say the funding boost from Medicaid has been transformative — enabling pediatric care, mobile outreach, and better emergency response. Losing that support would not only hurt patients but jeopardize entire clinic operations, particularly in underserved areas.

“We may have to scale back services, or worse — close facilities,” said Christopher Vann, a development lead at CommWell. “That’s going to hurt not just health care but employment and local economies.”

Disability loopholes raise alarm

Health workers are also concerned about vague definitions in the bill’s disability exemption. Many people with serious conditions don’t qualify for Social Security Disability Insurance (SSDI), which may become the default eligibility requirement under the new work rules.

Kate Daley of Down Home NC noted how slow federal disability approvals can delay care for years. “If it takes two years to get approved, that’s two years without treatment for someone with MS or lupus,” she said.

What does Medicaid mean to you or your family?

Do you rely on Medicaid for your health care in North Carolina or nearby states? Have you seen changes since expansion? Share your story with SaludaStandard-Sentinel.com — your voice could help shape this critical debate in the South.