NC House and Senate both vote for Medicaid funding, but can’t reach deal
Good morning and welcome to Under the Dome, I’m Luciana Perez Uribe Guinassi.
Everyone has likely heard the news by now: Medicaid cuts and changes are coming nationwide after Congress passed the “One Big Beautiful Bill.”
In North Carolina, reductions could arrive even faster as lawmakers remain split on how to provide additional state funding for the program, which covers more than 3 million residents. Cuts are set to take effect Oct. 1.
The Senate passed a bill to fund the program on Monday, and the House passed its version Tuesday. Both chambers voted unanimously to pass their versions of the bill. Lawmakers are expected to go home at the end of the week and not return until late next month.
The state’s Department of Health and Human Services has said that without more money, it must impose an across-the-board 3% provider rate cut, with some facing deeper reductions. Lawmakers provided $600 million for Medicaid in June. Such cuts could mean fewer doctors accepting Medicaid patients, layoffs or even closures.
Betsy MacMichael of Durham said Medicaid allows her 33-year-old daughter, Janie, who has a rare neurodegenerative disorder, to live independently.
“Medicaid is her health insurance, and it literally keeps our daughter alive,” MacMichael said at an advocacy event. Without access to her doctors and support, Janie would lose the ability to live on her own, work and enjoy her life, she said.
The main dispute between the two Republican-led chambers is whether to include money for NC Children’s, a planned pediatric hospital network led by Duke Health and UNC Health, and the NC Care Initiative, a rural health program run through ECU Health, UNC Health and their medical schools. With no comprehensive state budget, federal dollars set aside by the legislature two years ago for those initiatives have not been released. Senate leaders want the House to follow through; House leaders prefer a Medicaid bill without that funding.
A coalition of health care groups earlier this month urged the state to halt provider cuts so lawmakers can reach a resolution. DHHS said it would not.
Democratic Gov. Josh Stein on Tuesday said in a news release that with no agreement in sight, lawmakers are “closing off access to health care at a time when we need more. Failure to act will lose us critical federal funding and take more than a billion dollars total out of our state’s health care system, needlessly hurting people’s health, health care providers, and our economy.” The federal government matches state funding in Medicaid.
“What’s crazy is that both the House and Senate agree that more funding is needed, and they agree on exactly how much, but they’re allowing a separate disagreement between the chambers to sink this critical funding. They’re putting their politics ahead of our people. It’s inexcusable.”
DHHS’ estimate of needs is higher than that of the General Assembly’s Fiscal Research Division. Stein has previously said he’d compromise at the lower number with a commitment to reevaluate in January.
Lawmakers have called DHHS’s actions politically motivated and pinned blame on Stein.
After the House vote, Speaker Destin Hall reiterated that point, saying that according to a Fiscal Research analysis (which The News & Observer has previously requested) they likely had enough money to last until about June of next year. “It was really out of left field to see the governor come In and cut those rates,” he said. On not funding the hospital and rural program, Hall said “one General Assembly can’t bind another one.” He also said the House has not received “good answers” from the Senate on the need for funding the hospital, pointing to Duke and UNC having multibillion-dollar endowments.
Rep. Donny Lambeth, a top budget writer, said during floor debate on Tuesday that the Senate added to its bill “other items that are budget negotiation items. We don’t need to deal with that. We’ll deal with that as part of the budget talk.”
And Concord Republican Rep. Grant Campbell said: “These cuts are scheduled to start in a week. I want to stress that DHHS does not need to make these cuts right now. They will not run out of funding before the short session.”
He said there were health care providers across the state “that are already planning layoffs, and some are trying to decide whether to even continue seeing Medicaid patients at all.”
“This bill is a clean bill,” said Campbell, an OB-GYN. “There are no preconditions, there are no games. I’ll be leaving Raleigh Thursday and seeing patients on Friday and Saturday. This is very real to me.”
What else we’re working on
- Taxes, raises and past promises: What’s holding up NC’s state budget
- NC crime bill goes to Gov. Stein’s desk with changes to bail and death penalty laws
- After Kirk murder, NC lawmakers push tougher penalties for political violence
- Customers’ fees for credit card processing would be capped under NC bill
- NC bill bars Planned Parenthood from Medicaid, drawing concern on access to care
- In ‘107 Days’ book, Kamala Harris discusses NC visits, relationship with Cooper
- NC employers react, others remain silent, as Trump sets $100,000 H-1B visa fee
- Feds sending NC another $1 billion in emergency aid for Helene road repairs
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This story was originally published September 24, 2025 at 5:00 AM.
