On Oct. 1, more than $300 million in cuts to North Carolina Medicaid providers could begin because of an ongoing funding dispute. That's on top of the looming cuts to Medicaid expected from the "One Big, Beautiful Bill", which state health officials estimate could affect coverage for more than a quarter-million North Carolinians -- a disproportionate number of whom live in North Carolina's rural communities.
But there's also new money coming online specifically for rural healthcare. This week, the Rural Health Transformation Program -- established as part of the "One Big, Beautiful Bill" -- opened up for state applications, meaning billions of dollars could find their way to North Carolina as a result.
"The purpose of those monies would be to really transform rural health, which includes access to care," said Dr. Bryan Hodge, Chief Academic Officer for MAHEC -- the Mountain Area Health Education Center -- which works to train healthcare professionals in western North Carolina.
Hodge said delivering care to rural North Carolinians remains a challenge, especially in remote mountain communities.
"When we look at actually our health outcomes in those areas, we see that that burden is often passed along to the people living in those communities," he said.
Hodge acknowledged that federal cuts could make their work more challenging and are likely to affect many rural residents in North Carolina. As money from the Rural Health Transformation Program eventually becomes available, he said it could serve an important role -- and that they'll need it in light of the cuts.
"I think committing to making sure that we reduce every barrier to access so that people can actually see clinicians and have access to essential services, which I would say is primary care services, behavioral health services, ED services, maternity health services as local to them is possible. I think those are the level of things that we could see with this transformation opportunity," he said.
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State health officials are warning that more cuts could be coming to Medicaid coverage in North Carolina. Come Oct. 1, the North Carolina Department of Health and Human Services (NCDHHS) says it is expecting to face more than $300 million in additional Medicaid cuts because of an ongoing funding dispute, on top of the cuts expected by HR1.
Add it all up, and North Carolina's rural residents may face the brunt.
"We know that Medicaid disproportionately benefits rural communities in North Carolina. In fact, in North Carolina. 29 counties out of the 100 counties, you will see that 40% or more of their total population is enrolled in Medicaid," said Debra Farrington, Deputy Secretary for Health with NCDHHS.
Farrington said they'll be proactive in applying for funds from the new Rural Healthcare Transformation Program, but that money may not offset the loss in coverage ushered in by the cuts.
"It doesn't go directly to the pockets of any one individual, but it does help support the infrastructure," she said.