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NC Medicaid Coverage Report from NC Rural Center
Share of 19 to 64 year old NC population enrolled in Medicaid expansion
NC Rural Center Report
With coming cuts and changing requirements for Medicaid and SNAP, 672,000 North Carolinians who receive insurance through Medicaid Expansion may soon lose healthcare coverage.
Of that number, over 255,000 live in rural North Carolina. The Rural Center's new research report by Research & Data Manager Dalton Bailey looks at the data and explains why rural populations are more at risk of losing coverage than their more urban counterparts.
The Reconciliation Act (also known as H.R. 1 or the “One Big Beautiful Bill Act”) was passed on July 4, 2025. This expansive legislation includes cuts to Medicaid and SNAP, popular safety net programs (especially in rural North Carolina). Projections from health policy experts suggest that thousands of North Carolinians are at risk of losing at least part of their benefits through these programs, many of which live in rural communities. When taking into consideration rural people enroll in these programs at higher rates and are less digitally connected, these cuts will likely disproportionately affect rural people. We explore these cuts and the implications for rural North Carolina further in this report.
The Reconciliation Act:
Medicaid and SNAP
Cut Projections
PREPARED BY Dalton Bailey
Research & Data Manager
9-22-25
Executive Summary
The federal 2025 Reconciliation Act includes funding cuts and new requirements
for Medicaid and Supplemental Nutrition Assistance Program (SNAP). Many people
enrolled in these programs will lose some, or all, of their current benefits as a result.
Rural people enroll in those programs at a higher rate than their urban and suburban
counterparts and will likely face greater impacts from cuts.
Lost Coverage
The Medicaid Expansion population may suffer most. In order to pay for the costs
associated with providing care for the expansion population, the state taxes hospitals
providing care to fund part of the costs. The Reconciliation Act will cap the tax at a
lower rate than the state currently collects, meaning the expanded Medicaid program
established 2023 could end. As of July 2025, over 672,000 North Carolinians received
insurance through Medicaid Expansion. Over 255,000 of those live in rural counties.
Even if the state continues the Medicaid Expansion program, projections show that
new community engagement requirements will lead to lost coverage for thousands of
people. Similar engagement requirements will be expanded for SNAP, likely leading to
thousands losing SNAP coverage as well.
Projections Uncertain
Projecting losses in Medicaid and SNAP is difficult since they are expected to be
driven by confusion and failure to consistently report community engagement, even if
the requirement is being met. North Carolina health officials have projected 255,000
Medicaid recipients could lose coverage, about 38 percent of the Medicaid Expansion
population. Experts project around 1-in-8 SNAP recipients nationally could lose at least
some benefits. Assuming these rates hold true for rural North Carolina, over 96,000
Medicaid recipients and 75,000 SNAP recipients would lose coverage.
Rural Disparity
Online reporting requirements will require a reliable connection to high-speed internet.
Existing data shows that rural people are more likely to be underserved by internet
providers, and high-speed connections are typically more difficult to come by. While
projected losses are not concrete, it is almost certain that many people will lose their
Medicaid and SNAP benefits, and rural people will be affected disproportionately.
Snip...
PDF Download: https://www.ncruralcenter.org/wp-content/uploads/2025/09/Final_Medicaid_SNAP_Cuts_2025.pdf
Medicaid and SNAP
Cut Projections
PREPARED BY Dalton Bailey
Research & Data Manager
9-22-25
Executive Summary
The federal 2025 Reconciliation Act includes funding cuts and new requirements
for Medicaid and Supplemental Nutrition Assistance Program (SNAP). Many people
enrolled in these programs will lose some, or all, of their current benefits as a result.
Rural people enroll in those programs at a higher rate than their urban and suburban
counterparts and will likely face greater impacts from cuts.
Lost Coverage
The Medicaid Expansion population may suffer most. In order to pay for the costs
associated with providing care for the expansion population, the state taxes hospitals
providing care to fund part of the costs. The Reconciliation Act will cap the tax at a
lower rate than the state currently collects, meaning the expanded Medicaid program
established 2023 could end. As of July 2025, over 672,000 North Carolinians received
insurance through Medicaid Expansion. Over 255,000 of those live in rural counties.
Even if the state continues the Medicaid Expansion program, projections show that
new community engagement requirements will lead to lost coverage for thousands of
people. Similar engagement requirements will be expanded for SNAP, likely leading to
thousands losing SNAP coverage as well.
Projections Uncertain
Projecting losses in Medicaid and SNAP is difficult since they are expected to be
driven by confusion and failure to consistently report community engagement, even if
the requirement is being met. North Carolina health officials have projected 255,000
Medicaid recipients could lose coverage, about 38 percent of the Medicaid Expansion
population. Experts project around 1-in-8 SNAP recipients nationally could lose at least
some benefits. Assuming these rates hold true for rural North Carolina, over 96,000
Medicaid recipients and 75,000 SNAP recipients would lose coverage.
Rural Disparity
Online reporting requirements will require a reliable connection to high-speed internet.
Existing data shows that rural people are more likely to be underserved by internet
providers, and high-speed connections are typically more difficult to come by. While
projected losses are not concrete, it is almost certain that many people will lose their
Medicaid and SNAP benefits, and rural people will be affected disproportionately.
Snip...
PDF Download: https://www.ncruralcenter.org/wp-content/uploads/2025/09/Final_Medicaid_SNAP_Cuts_2025.pdf
Sources:
https://ow.ly/y4BF50WZwbE
http://www.ncruralcenter.org/2025/09/the-reconciliation-act-medicaid-and-snap-cuts/
Footnote/Reminder
Food Security reports have recently been halted by the T/V administration meaning that any future information likely will be either unreliable and/or non-existent.
You can call or visit the N.C. Rural Center at 919.250.4314
4021 Carya Drive. Raleigh, NC 27610
Their website is: https://www.ncruralcenter.org/
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