At the Kate B. Reynolds Charitable Trust, ensuring NC residents can access Medicaid is critical to our ongoing work to improve access to care so all people in our state can be healthy and thriving.
Starting January 2027, federal law will require adults enrolled in Medicaid expansion to document 80 hours a month of work, volunteering, or schooling to keep their coverage, unless they qualify for an exemption like pregnancy, caregiving, or medical frailty. Evidence shows that the majority of Medicaid enrollees are working, and this kind of policy strips health coverage from people through paperwork burdens rather than increasing employment.
An Interim Final Rule (IFR) from Centers for Medicare and Medicaid Services (CMS) goes even further than the law requires, adding new documentation hurdles and giving states room to pile on more red tape. The result will be deeper coverage losses that fall hardest on rural communities and communities of color.
In response, the Trust joined foundations across the county as part of a comment from Grantmakers In Health responding to the IFR. The Trust, in collaboration with other NC foundations, also submitted a letter to CMS, making it a part of the official public file that CMS must consider.
The truth is that these cost-heavy, administratively burdensome policies, present no meaningful, quantifiable gain for our state or its people. Instead, these policies place immense strain on the entire ecosystem of health care providers, local agencies, and community-based organizations who provide critical services to our most vulnerable populations. And philanthropy cannot fill the gap.
NC has successfully enrolled more than 3 million people in Medicaid overall, including nearly 740,000 North Carolinians who became newly eligible through Medicaid expansion in 2023.
This reflects a major win for NC residents and families, and we will continue to be among the many statewide partners who are committed to ensuring this important progress advances.