Intention to fix? Advocates plead for tweaks to NC Medicaid law to avoid cuts
AI-generated summary reviewed by our newsroom.
- Advocates urged NC lawmakers to amend HB 696 to avoid Medicaid coverage disruptions.
- House Bill 696 raised copays from $4 to $35, the federal maximum allowed.
- The law would end Medicaid for about 27,000 lawfully residing immigrants starting Oct. 1.
Advocates are continuing to push for changes to a Medicaid bill signed into law last month, arguing that several provisions could increase the number of uninsured North Carolinians and create new burdens for patients, providers and health systems.
On Tuesday, about 15 people, including faith leaders and members of congregations from across North Carolina, gathered at the General Assembly to deliver a letter to GOP lawmakers, urging them to quickly amend the law and avoid disruptions. They delivered the letter Tuesday morning to staff members for Senate leader Phil Berger and House Speaker Destin Hall.
“We’re very committed to the idea that North Carolinians are good people who love their neighbors, and we think if they knew what was at stake here, they would support these corrections,” said Jane Foy, a Quaker from Guilford County with New Garden Friends Meeting.
“HR 696 was necessary to extend Medicaid, but there were these, I think, inadvertent little glitches in the bill,” said Foy, who is a retired pediatrician. “We think that the legislators share our convictions, and we think if all this were transparent and the tremendous support we have for this correction, that I believe that will happen.”
Organized by Friends in Action at New Garden Friends Meeting, the letter was signed by more than 348 faith leaders and community members representing multiple faith traditions. While commending lawmakers for providing additional Medicaid funding, the signatories called on them to amend House Bill 696 by:
- Eliminating a provision that sets Medicaid copayments at the maximum level allowed under federal law.
- Revising a requirement that some Medicaid applicants demonstrate three months of work history before becoming eligible.
- Reinstating Medicaid coverage for certain lawfully residing immigrant children and pregnant women.
HB 696 provided $319 million in additional funding for the state’s Medicaid program to finish the fiscal year ending in June, matching the full amount requested last year by the state’s Department of Health and Human Services to cover a state funding shortfall.
The bill also includes a series of policy changes, including measures intended to align North Carolina’s Medicaid program with federal rules enacted as part of President Donald Trump’s agenda, such as requirements that some Medicaid recipients work or participate in community service beginning Jan. 1, 2027. The law also tightens oversight of the program, seeks to curb spending, and includes the changes advocates want fixed.
For Wendy Michener, who is self-employed, the three-month look-back period raises significant concerns. At 69 years old, she is on Medicare, but she said the Medicaid provisions could affect people in similar situations to hers. She said her work changes week to week and sometimes day to day. Recently, she has been doing childcare for families and delivering newspapers.
“Some weeks they’d need me, and some weeks they wouldn’t. There were people who came in intermittently. It would be huge. It would be impossible,” she said.
The bill increased copays for those covered under Medicaid expansion from $4 to $35, the maximum amount permitted under federal law.
Her stepdaughter is on Medicaid, and she said, “$35 to a legislator is lunch. $35 to someone like my stepdaughter is a crisis.”
27,000 immigrants
For Pam Schweigl, clerk of Friends Committee on North Carolina Legislation and a reproductive epidemiologist, one of the biggest concerns is the elimination of care for some immigrants. “It’s so important that we have prenatal care for everybody and healthy children,” she said.
The immigration provision takes effect Oct. 1 and would end Medicaid coverage for tens of thousands of lawfully residing immigrants, including 26,193 children and 505 pregnant women, a DHHS spokesperson previously told The News & Observer.
While federal legislation passed by Congress in July eliminated coverage for many categories of lawfully present noncitizens, it preserved an option for states to continue providing coverage to affected pregnant women and children, according to a DHHS email previously shared with The N&O. North Carolina currently uses that option and covers the roughly 27,000 lawfully residing immigrants.
Robert Jones, a retired hospital administrator, said the loss of coverage for 27,000 people would lead counties to pick up the tab, as counties are required to ensure access to prenatal care. “There’s a lot of pressure, especially in rural communities where they don’t have the resources,” he said.
On the co-pay, he said that in his experience many people in the state struggled even when it was just $4. Jones said there was a patient who lived about three blocks from a medical center where he worked who kept his appointments regularly when able, but after a leg injury, transportation became a barrier. It cost $1 for him to take the bus one way, which he did not have at that time, so he called an ambulance.
Jane Perrin, a retired psychologist, said the administrative changes in HB 696 “are going to detract from providers’ ability to spend time with their patients and add to costs, and especially in mental health care, where there’s very often not appreciable change from one month to the other.”
Intention to fix?
When Democratic Gov. Josh Stein signed the bill into law in late April, he praised lawmakers in the Republican-led General Assembly for reaching an agreement on additional Medicaid funding after negotiations had stalled for months. But he also raised concerns about the immigration provision, saying he believed, based on conversations he had had with lawmakers, that “the General Assembly’s intention” was to fix it. Stein also flagged the three-month look-back requirement and the co-pay provision.
Sen. Benton Sawrey, a Clayton Republican involved with health legislation, addressed the immigration provisions in comments to fellow lawmakers, saying that “no change, intention was contemplated at all to take these people off of Medicaid.”
“We’re going to continue to look at the issue and continue to have conversations about this extremely technical, complex issue with respect to Medicaid eligibility,” Sawrey said.
Rebecca Cerese, a health policy advocate for the left-leaning North Carolina Justice Center, said Tuesday that throughout this week, there will be more advocacy efforts calling for changes to the bill. Action is needed this week, she said, because waiting until a budget passes — which GOP leadership has indicated could happen by mid-June —will be “too late” because of notifications that need to be provided to those losing coverage.
Notification of the change that affects immigrants needs to be mailed this month, said Summer Tonizzo, a spokesperson with DHHS in an email to The N&O. Work would need to begin next week to allow for printing and mailing to be completed.
This story was originally published June 2, 2026 at 4:47 PM.
