Lawmakers and health officials are lauding a new deal to increase funding for Medicaid, the health care program that enrolls many low-income residents in rural southeastern North Carolina.
After a monthslong impasse, the Republican-led General Assembly approved $319 million in additional Medicaid funding last week. Democratic Gov. Josh Stein signed the measure, House Bill 696, into law.
The money will pay additional costs associated with operating the program, which provides health care benefits to more than 3 million low-income people across the state, including over 118,000 in Bladen, Columbus, Robeson, and Scotland counties.
The N.C. Department of Health and Human Services asked lawmakers for an additional $819 million last year for a Medicaid “rebase” to offset a shortfall created by increased costs. The legislature provided $500 million in July 2025 as part of a “mini budget.” House Bill 696 closed the remaining gap.
North Carolina has the seventh-highest Medicaid enrollment in the country, according to data from the Centers for Medicare & Medicaid Services. Enrollment has steadily increased over the years, most sharply after the state passed Medicaid expansion in 2023.
In the Border Belt, 66,000 Robeson County residents are enrolled in Medicaid, about 57% of the total population. It’s the eighth-highest total enrollment across North Carolina’s 100 counties. About 50% of Scotland County residents are enrolled in Medicaid, and 47% in Bladen County.
“Ensuring North Carolina’s Medicaid program is properly funded is critical to supporting the individuals and families who rely on it every day,” Rep. John Lowery, a Robeson County Republican and the chairman of the Lumbee Tribe of North Carolina, posted to Facebook on April 29.
Medicaid costs have steadily increased since 2020, according to annual reports from the N.C. Department of Health and Human Services. In 2020, the program’s total expenditures were over $16.82 billion. In 2024, North Carolina spent more than $27.7 billion on the program.
Federal and state governments split Medicaid costs. In 2024, the federal government gave more than $18.8 billion to North Carolina for Medicaid, according to the annual reports, while the state provided over $8.91 billion.
North Carolina’s Medicaid costs are expected to increase by millions annually starting in 2027 as the state implements provisions of the federal One Big Beautiful Bill Act, according to a fiscal note attached to House Bill 696. The legislation expanded the population that must meet work requirements and increased the number of times officials must certify someone is still eligible for benefits. It didn’t provide any funding to states to implement the requirements.
House Bill 696 requires Medicaid applicants to meet the requirements for at least three months before applying. It’s significantly stricter than the federal one-month lookback period, which most states plan to follow, according to a poll by KFF.
Some of the program’s rising costs stem from applied behavior analysis (ABA) therapy, a treatment for children with autism and other developmental disorders, according to an analysis by NC Health News. The state cut ABA services late last year, but a lawsuit forced the it to reverse the cuts.
Part of House Bill 696 restricts what kind of ABA therapy Medicaid will pay for, including limiting the amount of telehealth used and requiring more services to be given by specific providers.
The recently passed Medicaid funding is welcome news to Trillium Health Resources, which manages behavioral health and developmental disabilities services for Medicaid recipients across eastern North Carolina.
“This funding represents an important step in maintaining access to care for those who rely on Medicaid,” Joy Futrell, the organization’s chief executive officer, said in a news release. “Providers rely on sufficient and predictable funding so they can continue delivering high-quality services to communities across North Carolina.”
Provisions in House Bill 696 require the state Department of Health and Human Services to create an annual Medicaid “fraud, waste, and abuse” report for the General Assembly’s Joint Legislative Oversight Committee on Medicaid and the Fiscal Research Division. The legislation also directs the department to create a plan to improve “integrity, cost-savings, and efficiency measures in the Medicaid program.”
“While Medicaid costs continue to rise, I strongly believe the oversight measures included in [House Bill] 696 will help lower the state’s long-term Medicaid spending and ensure taxpayer dollars are being used responsibly,” Rep. Brenden Jones, the House majority leader representing Robeson and Columbus counties, said in a written statement.
Under the new law, the state Department of Health and Human Services must review Medicaid recipients’ eligibility every month, instead of quarterly.
Any applicant whose citizenship or immigration status cannot be verified “shall promptly” be referred to the U.S. Department of Homeland Security, according to the law.
Under the new law, North Carolina becomes the 11th state in the country to not offer Medicaid to immigrant children and pregnant women who are legally in the United States but aren’t citizens. Stein said nearly 27,000 pregnant women and children legally in North Carolina, “including victims of human trafficking, green card holders, and refugees,” will lose their health coverage because of the legislation. He called on state lawmakers to “fix this issue” during the ongoing short session.
Stein also noted that the law increases copayments for Medicaid expansion beneficiaries for certain services to the maximum allowed under federal law. Under the One Big Beautiful Bill Act, those covered under Medicaid expansion can be charged up to $35 for certain services.
Stein also took issue with what he called “onerous red tape” the bill places on beneficiaries, which he said will force people to wait months for services they are eligible to receive.
“Nevertheless, this bill moves North Carolina forward by addressing many critical needs facing state government and the people we serve,” Stein said.