By Heidi Perez-Moreno
heidiperez-moreno@borderbelt.org
Potential federal spending cuts that could affect social services like Medicaid and food assistance are raising concerns in rural southeastern North Carolina.
The House Energy and Commerce Committee, which oversees public health funds, could cut at least $880 billion. The cuts would likely impact Medicaid, which helps cover health care costs for children and low-income or disabled adults, and the Supplemental Nutrition Assistance Program, commonly known as food stamps.
North Carolina is one of 12 states that imposed a “trigger law” that would drop Medicaid expansion if the federal government lowers its match rate below 90% of the cost. State lawmakers approved Medicaid expansion in late 2023, opening the program to hundreds of thousands of low-income adults who had previously made too much money to qualify.
Nearly 25,000 residents in Bladen, Columbus, Robeson and Scotland counties have signed onto Medicaid since then, bringing the total beneficiaries in the region to more than 118,000—about half the population.
Medicaid expansion particularly benefits economically distressed rural areas with higher rates of uninsured residents and less access to health care services, said Columbus County Health Director Kim Smith, who is retiring at the end of April. Fourteen percent of Columbus County residents do not have health insurance, compared to 11% statewide, according to the latest County Health Rankings report.
“If you don’t have the money to buy a Cadillac, you certainly can’t go out and get it,” Smith said. “It’s the same way with health care. An individual will end up in the emergency room, and that might be the only place they can see a physician and get anything diagnosed.”
Bladen County Health Director Terri Duncan said it’s tough to predict local impacts of federal cuts. “We don’t have enough information right now,” she said. “It could be a rapidly changing situation.”
Medicaid cuts could also impact Medicare, which provides health care coverage for people 65 and older, according to the Medicare Rights Center, a national nonprofit organization that said any stressors to a state’s budget could put programs at risk.
Nearly 10 million low-income seniors and people with disabilities—so-called “dual eligibles”—are enrolled in both Medicare and Medicaid in the United States, according to the Center on Budget and Policy Priorities.
Republican state Senate Leader Phil Berger told reporters in March he doesn’t expect major Medicaid cuts. But some others, including Republican Rep. Donny Lambeth of Winston-Salem, said lawmakers should prepare anyway. Lambeth introduced a House bill that would create a Committee on Medicaid Sustainability to address potential cuts.
Gov. Josh Stein and Dev Sangvai, secretary of the N.C. Department of Health and Human Services, held a roundtable discussion with rural health providers on April 3 in Nash County.
“Any cuts to Medicaid or the direct payment programs that reimburse hospitals for their services to these patients would have catastrophic and unintended consequences,” L. Lee Isley, president and chief executive of UNC Health Nash, said in a news release. “Not only would these cuts significantly limit patient access to healthcare, but they would force rural hospitals to shutter services that are essential to the health of a community.”
UNC Health Southeastern in Robeson County declined to comment for this story. “We will reconsider providing a comment once things are more certain,” hospital spokesperson Amanda Crabtree said in a statement to the Border Belt Independent.
SNAP and WIC benefits
A report from the Center on Budget and Policy Priorities said the health cuts would worsen food insecurity for families and hurt local businesses that accept SNAP benefits.
WIC, a federal program that provides food and health services to low-income pregnant women and at-risk children up to age five, would also likely be affected. The National WIC Association said in a release that applicants typically use Medicaid or SNAP participation as proof they are eligible for WIC benefits.
Interim Columbus County Health Director Daniel Buck said the county has taken on some WIC-associated costs, stretching the local budget.
If cuts are severe, Buck said, the county will look to grants and other funding opportunities to fill gaps.
“It would be a total shock to the system,” he said. “And we’re not really sure who would pay—someone’s got to pick up the tab.”
