Months-long Medicaid funding impasse ends as Gov. Josh Stein signs $319M deal
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- Gov. Josh Stein signed a $319 million Medicaid bill two days after legislative approval.
- The bill requires some Medicaid recipients to work starting Jan. 1, 2027.
- It cuts coverage for lawfully residing children and pregnant individuals, officials say.
The months-long impasse over Medicaid funding came to an end on Thursday.
Democratic Gov. Josh Stein moved quickly, signing the bill into law just two days after it received final bipartisan approval from the GOP-led House and Senate.
It marked a significant breakthrough after Republican lawmakers in both chambers were unable to reach agreement among themselves last year and also failed to strike a deal with the Stein administration on additional Medicaid funding to cover a projected shortfall. Lawmakers had already provided about $600 million, but the state’s health and human services department said more was needed to keep the program financially stable through June.
At stake was ensuring Medicaid — which provides health coverage for 3 million North Carolinians — remained fully funded through the end of the fiscal year in June, so providers could be paid and continue delivering care to Medicaid patients.
The bill cleared both chambers with near-unanimous support, though some Democratic lawmakers raised concerns about certain provisions, primarily those related to immigration.
Spanning 33 pages, the legislation does several things: It aligns the state with Medicaid rules introduced by the Trump administration. That includes rules requiring some Medicaid recipients to work or participate in community service beginning Jan. 1, 2027.
The bill also includes provisions to tighten oversight of the program, curb spending and limit access to the insurance program for immigrants. One immigration provision would require, beginning in October, that any Medicaid applicant or recipient whose citizenship or “satisfactory” immigration status cannot be verified be referred to the federal government. Another provision would cut Medicaid coverage for thousands of lawfully residing immigrant children and pregnant individuals, according to DHHS. North Carolina Medicaid is currently covering about 27,000 of those lawfully residing individuals, including 26,193 children and 505 pregnant women, a DHHS spokesperson said.
Concerns were also brought up by a coalition of about 50 organizations, including the ACLU of North Carolina, Action NC, the North Carolina Justice Center, El Pueblo, and MomsRising. This coalition sent a letter to lawmakers this week opposing several provisions in the bill and calling on lawmakers to pass a “future cleanup bill.”
“The administrative burdens from many of these changes will especially impact North Carolinians with disabilities and those in rural areas who may experience greater difficulty obtaining and returning required paperwork, causing eligible individuals to lose needed health coverage,” the letter states.
As for the reason for the long impasse?
Lawmakers in the Senate and House disagreed on policy provisions to include in the bill. For example, the Senate sought to include funding for a children’s hospital being developed by Duke and UNC Health, a proposal previously agreed upon with former House Speaker Tim Moore. Senate leader Phil Berger has said that negotiations on that will continue with budget talks. The state was supposed to pass a new budget by last June.
Lawmakers also initially disagreed with Stein and his administration’s $319 million estimate, instead pointing to lower figures from the General Assembly’s Fiscal Research Division. They further pushed back after Stein’s administration implemented cuts to provider reimbursement rates in response to the shortfall. Those cuts were later reversed following lawsuits filed by providers and health care recipients.
This story was originally published April 30, 2026 at 11:31 AM.
