Advocating for Change, Protecting Medicaid in North Carolina
In December 2023, the North Carolina legislature passed a bill to expand Medicaid, significantly increasing the number of individuals eligible for coverage. The expansion led to increased demand for providers, as well as a corresponding rise in regulatory burden. The Foundation responded by issuing a special call for proposals to address Medicaid expansion. in the Greater High Point Community. Through four grants, the Foundation is funding organizations to increase their capacity to serve the growing number of Medicaid recipients. Grantees include Caring Services, the Nurse-Family Partnership, the Center for New North Carolinians, and Mental Health Associates of the Triad in collaboration with The Bridge, Triad Adult & Pediatric Medicine, and The Community Clinic of High Point.
Medicaid expansion is now at risk in North Carolina due to the budget deliberations underway in Washington. The federal budget passed by the US House of Representatives in February calls for $880 billion in cuts to Medicaid funding over the next ten years.
The North Carolina expansion legislation contains a “trigger law” that dismantles expansion if federal funding is reduced or eliminated, endangering affordable coverage for more than 650,000 new Medicaid recipients.
On Thursday, May 8, the Foundation for a Healthy High Point hosted a special convening titled Medicaid, Meals, and More: Facing Federal Cuts with Local Strength, focused on increasing enrollment locally and advocating to protect Medicaid funding.
Representatives from the four funded partners shared stories and challenges around the implementation of Medicaid expansion. While challenges exist, a common thread emerged from a discussion of the positive effects of expansion, including the ability to serve more clients, better outreach to the community, transportation is available when seeking medical care, education outreach to new enrollees. And ultimately, lives are saved. “People die without health care, and people are afraid of health care in a lot of ways,” said Teresa Hinkle, Executive Director of Caring Services. “Medicaid expansion is giving us the tools and the language to talk to people in a way that allows them to take care of themselves. What a gift that is.”
Attendees also heard from Abby Carter Emanuelson, Executive Director of the North Carolina Alliance for Health, a public health advocacy organization and a member of Care4Carolina, which was initially founded to advocate for expanded Medicaid coverage. Emanuelson shared sobering news about changes in the nonprofit sector at both the federal and state levels. “We’re really mobilizing around one of the most dangerous moments for public health that we’ve seen in decades. It feels like wave after wave of discouraging news coming down from D.C., ignoring the needs of everyday North Carolinians and shifting significant costs to states that are already dealing with their own shortfalls.” Since January, there has been an unprecedented number of Executive Orders and Congressional funding bills resulting in both real and proposed funding cuts. Most significant to Medicaid are proposed cuts of $880 billion. Whether these cuts take the form of a reduction in the federal match or more stringent eligibility rules such as work requirements, they would have a catastrophic effect, drastically reducing the number of eligible participants.
But amid these challenges, there is reason for hope. “It’s not all doom and gloom. I’m not here today to talk about what’s been lost, but what we’re doing and can do. North Carolina has a deep strength in its people and in its organizations and partnerships,” said Emanuelson. “Through this strength, we can push back, adapt, and continue to protect our communities. We know how to fight together.” North Carolina is a coalition-driven state with a history of successful advocacy when hospitals, health departments, advocacy groups, and community members band together. “As a state, we elevate community voices, we have a lot of good research and are able to pair data with stories of lived experiences. And we’re resilient and adaptable.” The same guidelines that applied to Medicaid expansion are relevant now.
When it comes to “facing federal cuts with local strength,” advocacy matters. Medicaid expansion came about through a 10-year effort during which advocates persisted, adapted, and won. “And now, because Medicaid is being attacked federally, the Alliance stands ready to get the band back together and lead the defense effort to amplify all the good work that’s being done,” said Emanuelson. Most of the Alliance’s work is centered around coalition building and advocating in the North Carolina General Assembly, but in the current environment, the state legislative strategy has been expanded to include federal action. “This week, we joined more than 20 North Carolina anti-hunger organizations to attend advocacy trainings and meet with our North Carolina delegation to oppose cuts to SNAP and Medicaid,” said Emanuelson. “North Carolina’s Congressional offices are hearing from us and from their constituents, and it’s causing divisions and slowing down the budget reconciliation process. And that’s hopeful.” State legislators are responding both to feedback from their constituents and to the realization that federal budget negotiations will push costs back to the states. And advocacy at the federal level continues to be crucial to defending Medicaid.
Emanuelson outlined practical steps we can all take. Stay informed – know what is being proposed, what has passed, and what is coming. Tell stories – lawmakers respond to compelling stories that demonstrate the impact on individuals. Join coalitions – collective action multiplies our efforts. Use your influence, whether you’re an organizer, provider, teacher, volunteer, or pastor. And keep showing up. “It’s consistency that wins policy changes,” said Emanuelson. “It’s relationships, even when you disagree with someone. It’s not a one-time outrage that gets the work done.”
Protecting Medicaid is vital to the health of the High Point community and North Carolina, as it provides health coverage to one in four North Carolinians. Even a fraction of the proposed cuts will result in a drastic loss of coverage and a rise in preventable illness and death. Emanuelson says, “These proposed cuts are real, and they’re dangerous, but they’re not inevitable. Together, we can bridge the gap and defend what matters. And together, we can protect the health and dignity of every person in our state.”