06/17/2025
New Study Warns of Significant Harm to North Carolina Community Health Centers from Medicaid Changes Proposed by Both Chambers of Congress
The North Carolina Community Health Center Association (NCCHCA) is sounding the alarm following the release of a new study, which reveals that Medicaid work requirements proposed by Congress would cause devastating financial losses to Community Health Centers (CHCs). Today, Community Health Centers provide comprehensive primary care across over 600 clinical locations in 92 counties for over 762,000 North Carolinians, regardless of their ability to pay. Health centers work together with the Medicaid program, which covers 1 in 4 North Carolinians, to keep people healthy and out of emergency rooms, saving money for taxpayers.
According to the new study, North Carolina’s Community Health Centers could face cuts to over 70 percent of their annual Medicaid reimbursements—over $100 million per year—if Congress enacts federal Medicaid work requirements as proposed in the One Big Beautiful Bill Act passed by the U.S. House of Representatives in late May and as proposed just this week by the Senate Finance Committee.
The study highlights that many CHC patients, despite being eligible for Medicaid, would lose their coverage due to administrative barriers under a work requirement system in which their employment or exemptions must be manually documented and verified. In states like Arkansas, similar requirements have led to disenrollment rates as high as 72%, even among those who met the criteria. If North Carolina is required to fast-track implementation of work requirements as proposed by the House bill, an estimated 89,000 health center patients could lose Medicaid coverage due to administrative hurdles. Under the Senate proposal, states would have more resources and could request a longer glide path to develop systems needed to automate some of the requirements, which could reduce some of the paperwork obstacles that would push North Carolinians off their Medicaid coverage.
“The data show that even North Carolinians who are working or exempt from the requirements will still lose their Medicaid coverage under these proposals,” said Chris Shank, President and CEO of NCCHCA. “The administrative burden on local Departments of Social Services—and on Medicaid enrollees alike—to meet new manual, paperwork requirements will result in tens of thousands of health center patients losing Medicaid coverage and becoming uninsured.”
In order to meet their mission, Community Health Centers depend on third party reimbursements for services provided to patients with health coverage. With these projected coverage losses, health centers stand to lose not only revenue from foregone reimbursements, but they face increased costs associated with caring for newly uninsured patients. Federal grant funding for CHCs, another critical revenue source, has been flatlined for a decade despite rising costs and increased demand for services. All told, the financial strain from these coverage losses could force health centers to reduce services, lay off staff, or close sites—jeopardizing access to care for hundreds of thousands of North Carolinians.
“We urge Congress to reconsider these harmful provisions,” said Shank. “Community Health Centers are a lifeline for underserved communities. These changes would undermine decades of progress in expanding access to care in rural North Carolina.”
https://www.ncchca.org/new-study-warns-medicaid-changes/
