Medicaid Cuts Threaten Access to Care in North Carolina and Beyond
As state budgets tighten, vulnerable patients and caregivers face reduced access to vital healthcare services.
Across teh nation, states are grappling with budget shortfalls, and Medicaid, the government health insurance program for low-income individuals and people with disabilities, is increasingly becoming a target for cuts. these reductions in funding are already impacting access to care, particularly in states like North Carolina and Idaho, and raising concerns about a broader national trend.
For nearly 18 years, Alessandra Fabrello has served as the primary medical caregiver for her son, Ysadore Maklakoff, in addition to being his mother. “It is almost impossible to explain what it takes to keep a child alive who should be dead,” Fabrello explained. She recently received a call from her son’s dentist, informing her that the office will no longer accept Medicaid patients starting in november. She fears this will be a recurring pattern, leaving her son eligible for services he simply cannot access.
“When you say, ‘We’re just cutting provider rates,’ you’re actually cutting access for him for all his needs,” Fabrello stated.A former chief medical officer for North Carolina Medicaid, Shannon Dowler, echoed this concern, noting that reduced payments will inevitably lead to fewer providers participating in the state’s Medicaid network, resulting in “an immediate loss of access to care, worse outcomes, and cause higher downstream costs.” Dowler emphasized that these cuts are not directly tied to recent federal legislation reducing Medicaid funding, but rather a proactive measure by North Carolina to address its own budgetary issues.The state is projected to lose approximately $23 billion in federal Medicaid dollars over the next decade.
North Carolina is implementing pay cuts for all providers who treat Medicaid patients, with primary care doctors facing an 8% cut and specialists experiencing a 10% reduction, according to the North Carolina Department of Health and Human Services. More than 3 million North Carolinians are currently enrolled in Medicaid. State lawmakers, deadlocked on broader budget issues, approved a mini-budget in July that provided the Medicaid agency with $319 million less than requested. Lawmakers retain the option to reinstate funding for Medicaid this fiscal year, Dowler noted, adding that failure to do so will likely result in more practices dropping coverage for Medicaid members.
The situation in North Carolina reflects a broader national trend. States have been relying on federal resources, including pandemic-era funding, to bridge budget gaps. With those funds now depleted,states are facing difficult choices: eliminate optional program components or reduce provider payments. Jay Ludlam, deputy secretary for North Carolina Medicaid, described the current budget cut as “absolutely the opposite direction of where we really want to go, need to go, have been headed as a state.”
In Idaho, state leaders responded to an $80 million budget shortfall this month by cutting Medicaid pay rates by 4% across the board. This move has sparked backlash from nursing home operators and patient advocacy groups, with one nursing home company warning in an op-ed in the Idaho statesman newspaper that the cuts could force them to reduce staff or limit admissions. The Idaho Hospital Association’s Toni Lawson reported that some hospitals in the state are operating with less than two days of cash on hand, and anticipates that labor and delivery and behavioral health units-already financially vulnerable-will be the first to face cuts.
Nationwide, Medicaid accounts for an average of 19% of a state’s general fund spending, second only to K-12 education, according to Brian Sigritz, director of state fiscal studies for the National Association of State Budget Officers.While states experienced strong revenue growth in 2021 and 2022, that growth has slowed, and many states have simultaneously reduced income and property taxes.
Fabrello, who was on the brink of financial ruin before the state began compensating parents for caregiving duties, now faces a salary cut due to the Medicaid reductions. “As parents, we are indispensable lifelines to our children, and we are struggling to fight for our own survival on top of it,” she said. The cuts underscore the precarious position of families relying on Medicaid for essential care,and the difficult choices states are making as thay navigate increasingly strained budgets.
