WNC Health Policy Updates

March 23, 2026

This Past Week Included 

• Mission Hospital submits corrective plan after federal “Immediate Jeopardy” finding; must meet CMS compliance standards by July or risk losing Medicare and Medicaid funding, raising major concerns for regional access to specialized and emergency care in WNC

• NC lawmakers are considering changes to nonprofit hospital tax exemptions, citing concerns that hospitals receive around $1.8B annually in tax breaks without proportional charity care, with potential impacts on rural hospital stability and service capacity in WNC

• Lawmakers raised concerns over rapid growth in autism therapy spending, prompting discussions about cost drivers, oversight, and long-term sustainability within North Carolina’s Medicaid program

• State budget projections indicate slowing growth in federal Medicaid funding, with some estimates dropping from $19B to $17.9B, increasing concern among lawmakers about potential shortfalls before the end of the fiscal year

March 16, 2026

This Past Week Included

• The WNC Health Policy Initiative hosted its 2026 Legislative Summit at UNC Asheville, bringing together about 130 policymakers, healthcare leaders, and community stakeholders to discuss access to care, healthcare workforce shortages, and social drivers of health. Speakers included Lt. Gov. Rachel Hunt, Dogwood Health Trust CEO Susan Mims, MAHEC CEO William Hathaway, UNC Asheville Chancellor Kimberly van Noort, and Impact Health CEO Laurie Stradley.

• A bipartisan housing proposal passed in the U.S. Senate aimed at increasing housing supply through construction incentives and limits on large institutional homebuyers.

• North Carolina officials announced the State Health Plan will open a competitive bidding process for its claims administration and pharmacy benefit contracts rather than extending current agreements with Aetna and CVS Caremark.

• North Carolina officials reported early progress on the Children and Families Specialty Plan, a Medicaid program designed to coordinate healthcare for youth involved in the foster care system. Since launching in December 2025, the program has enrolled more than 32,000 youth and reduced the average time needed to arrange services from about 45 days to 16 days. 

March 9, 2026 

This past week included: 

• Primary election results were tallied on March 3, 2026. Here are some pertinent results:

  • U.S. Senate: Democrat Roy Cooper and Republican Michael Whatley won their respective primaries and will face each other in the general election to replace the seat currently held by Thom Tillis.

  • U.S. House District 11:Incumbent Republican Chuck Edwards and Democrat Eric Ager advanced from their primaries and will compete in November to represent Western North Carolina in Congress.

• Lawmakers on the North Carolina Child Fatality Task Force voted to support restoring funding for the North Carolina Perinatal Quality Collaborative, which lost funding during a 2025 budget dispute. Legislators from both parties have expressed interest in restoring the program’s $905,000 annual budget during the upcoming legislative session.

• North Carolina’s State Health Plan introduced a new benefitthat would allow surgeries such as joint replacements and cardiac procedures to be performed with no out-of-pocket cost when members use providers through the Lantern specialty care platform.

• New research from North Carolina State University suggests that states relying more heavily on sales tax revenue tended to lift COVID-19 stay-at-home orders earlier than states with other tax structures. 

• The federal government has proposed updates to registration requirements in the System for Award Management (SAM) for organizations receiving federal grants or cooperative agreements. Public comments on the proposal are open through March 30.

• The letter-of-intent deadline has passed for organizations seeking to serve as Western North Carolina’s ROOTS Hub under the NC Rural Health Transformation Program, which could bring up to $1 billion in federal funding to North Carolina over five years. Full applications are due April 2. 

March 2, 2026 

This past week included: 

• NC Medicaid Director Jay Ludlam announced his departure from the NC Department of Health and Human Services, raising questions about leadership continuity as Medicaid operational reforms (especially behavioral health expansions) continue.

• Early voting for the 2026 March 3 primary concluded, and health policy remains a topic in several statewide and district races; voters can review sample ballots to see related initiatives and candidate positions.

• Health organizations across NC continue applying to serve as NC ROOTS Hubs, an initiative aimed at expanding regional behavioral health coordination, integrating social and medical care, and boosting community resilience. 

• North Carolina lawmakers continued reviewing legislative proposals that would modify how involuntary outpatient commitment is used.

• Local and state health departments have emphasized the importance of maintaining measles vaccination availability and community outreach in areas with identified under-vaccination.

February 23, 2026

This past week included:

• North Carolina released progress on its 2025-2027Behavioral Health Strategic Plan, highlighting early expansions in mental health and substance use treatment services, while noting ongoing access gaps.

• State officials reported rising measles cases statewide and urged vaccination to prevent further spread, reaffirming concerns about declining childhood immunization rates.

• North Carolina remains without an enacted state budget for the 2025-2027 biennium as of mid-February 2026. This delay continues to create uncertainty in Medicaid planning, staffing for health programs, and long-range health policy implementation.

  • State Representative Deb Butler (D-New Hanover) and members of the NC Progressive House Caucus proposed a constitutional amendment to withhold pay from legislators until a state budget is passed in hopes of breaking the budget impasse.

• Federal officials (HHS/CMS) released the proposed 2027 ACA Marketplace “Notice of Benefit and Payment Parameters”, signaling potential changes influencing premiums, eligibility verification, insurer participation standards, and plan design flexibility for North Carolina residents.

February 16, 2026 

This past week included: 

• North Carolina’s state budget impasse continued as lawmakers failed to reach an agreement, keeping the state operating under last year’s funding levels.

  • Members of the NC Progressive House Caucus proposed a bill that would withhold legislators' pay until a budget is passed.

• Early voting for North Carolina’s March 3 primary election began statewide, alongside renewed attention to federal voting legislation.

• The U.S. House–passed SAVE Act would require documentary proof of citizenship to register to vote, such as a passport or birth certificate. The measure could create barriers for newly married voters, people who have recently moved, and first-time voters if enacted.

• The Centers for Medicare & Medicaid Services released a proposed 2027 Notice of Benefit and Payment Parameters for the Affordable Care Act. The proposal outlines stricter eligibility verification, reduced enrollment flexibility, and limits on federal subsidy spending. If finalized, the rule could reduce national ACA enrollment by an estimated 1.2–2 million people.

• Measles cases continue to rise in North Carolina. Approximately 21  cases have been reported statewide and at least seven have been confirmed in Buncombe County. State health officials have expanded vaccination outreach and public exposure notifications. The MMR vaccine remains the most effective tool for preventing further spread, particularly among unvaccinated children and adults without documented immunity.

February 9, 2026

This past week included: 

• The North Carolina Department of Justice announced a $17.85 million settlement with generic drug manufacturers Lannett and Bausch Health over allegations of long-running price-fixing that increased prescription drug costs. North Carolina also joined a multistate lawsuit against Novartis and its Sandoz subsidiary alleging similar anticompetitive practices.

• Governor Josh Stein signed Executive Order No. 33, directing state agencies to improve coordination between North Carolina’s behavioral health system and the criminal justice system. The order focuses on crisis response, behavioral health workforce capacity, involuntary commitment processes, and access to treatment in justice-involved settings.

• Measles cases continued to increase statewide, with NCDHHS reporting approximately 15–17 cases since late December and the first hospitalization of the current outbreak. Cases have been identified in multiple regions, including Western North Carolina. NCDHHS expanded vaccination outreach and public exposure notifications.

• The Governor proclaimed February 2026 as Heart Health Awareness Month and February 6 as National Wear Red Day.

• With the March 3, 2026 primary election approaching, North Carolina entered a heightened phase of campaign activity and voter engagement. Election administration and voter access issues remained active topics in state policy discussions.

February 2, 2026

This past week included: 

• The North Carolina Department of Health and Human Services (NCDHHS) extended temporary Medicaid flexibilities for beneficiaries due to the January winter storm. These provisions included early prescription refills and adjusted submission protocols for pharmacy claims to ensure access during the state of emergency.

• State Medicaid officials have begun discussing strategies for covering rising administrative costs and preparing for federal Medicaid work requirements that could take effect under recent federal law changes. Proposed options include assessing provider taxes, shifting costs to insurers, and tapping state savings.

• Funding shifts have led to changes in the NC Medicaid Member Ombudsman program. As of January 2026, contract services previously run by Legal Aid ended due to budget shortfalls, and essential ombudsman functions moved directly under NCDHHS with some scaled-back services.

• New federal Medicaid policy changes under the H.R. 1 reconciliation law are starting to roll out with implications for eligibility and operation of NC Medicaid.

January 26, 2026

This past week included: 

• Updated Medicaid fee schedules and provider payments took effect with the reversal of prior reimbursement rate cuts, ensuring providers receive full pre-cut payment rates. However, the underlying state budget gap for Medicaid funding remains unresolved, placing pressure on legislators to reach a long-term fiscal solution. 

• North Carolina’s largest health systems halted gender-affirming care for youth under age 19, leaving fewer treatment options for transgender adolescents and raising concerns among advocates about continuity of care and access to services for this population.

• State officials began planning a proposed $1 billion rural health initiative, outlining steps to deploy federal funds to improve care in rural counties while lawmakers discuss equity and access considerations.

• State health officials outlined early implementation plans for a federal Rural Health Transformation Program, as North Carolina prepares to utilize an initial $213 million award from the program to improve rural health care access, address provider shortages, and expand services in underserved communities. 

January 12, 2026

This past week included: 

• North Carolina officials urged the General Assembly to finalize the long-delayed state budget, as the state continues operating under last year’s funding levels amid disputes over income tax cuts and pay raises.

• NCDHHS reported an additional measles case in Rutherford County, bringing North Carolina’s total to five cases since late December. Health officials urged vaccination for all unvaccinated individuals age 1+ and emphasized immunization as the most effective prevention strategy.

• Gov. Josh Stein highlighted Hurricane Helene housing recovery efforts in Western North Carolina, including a $300,000 state grant to repair at least 20 storm-damaged homes and an additional $18 million approved to expand volunteer-based home repair programs. 

• After the U.S. Department of Health and Human Services froze child care and family assistance grants in five states, concerns spread in North Carolina. However, AG Jeff Jackson and NCDHHS Secretary Dev Sangvai said no freeze has been issued for NC, and the Jan. 5 warning does not apply to the state’s reimbursement-based subsidy system.

• A bill to eliminate DEI programs at public universities (SB 558) remains stalled, as the NC House has repeatedly delayed a veto override vote due to a narrow Republican margin. Legislative leaders continue holding the bill and other vetoed measures on the calendar pending favorable vote conditions.

December 22, 2025 

This past week included: 

• NCDHHS was directed to reverse the October Medicaid reimbursement rate reductions last week. State officials continued to warn that a roughly $319 million Medicaid funding gap remains without legislative action.

• State Health Plan leaders emphasized a shift toward preventive and population-health investments as part of broader cost-containment strategies for 2026.

• Housing affordability and supply shortages continue to dominate policy discussions in North Carolina, drawing sustained attention from state and local leaders.

December 15, 2025 

This past week included: 

• Gov. Josh Stein halted planned Medicaid provider rate cuts, and restored reimbursement levels after legal and legislative challenges.

• A North Carolina Health News investigation reported that some hospitals are charging patients separate fees for completing health questionnaires.

• The North Carolina General Assembly will not hold additional votes in 2025 and will continue to operate without a full state budget. Key investments and adjustments across health, Medicaid, and public health programs have been delayed. 

December 8, 2025 

This past week included: 

• A federal committee voted to end the longstanding universal birth-dose recommendation for the hepatitis B vaccine for newborns.

• Hidden PFAS pollution uncovered in NC, while EPA proposes a rollback in reporting for businesses that make or use PFAFS.

• Iryana’s law was enacted as House Bill 307 and officially took effect on December 1, 2025.  Governor Stein criticizes parts of the bill. 

• NCDHHS launches the Children and Families Specialty Plan (CFSP), a statewide Medicaid-managed care plan specifically for children, youth, and young adults currently or formerly served by the child welfare system.

• NCDHHS launches Student Loan Repayment Program designed to bolster the mental health, substance use, I/DD and TBI workforce.

• The State Health Plan announced that its projected 2025 deficit has now been resolved.

December 1, 2025

This past week included:

• NCDHHS advanced a $1 billion Rural Health Transformation proposal, submitting its formal application to CMS.

• A Wake County court temporarily halted Medicaid rate cuts to intensive autism therapy services. 

• North Carolina Department of Health and Human Services (NCDHHS) opened the state’s second mobile opioid-treatment program.

November 24, 2025

This past week included: 

• North Carolina submitted its application to draw down up to $200 million through the federal Rural Health Transformation Program.

• A federal court upheld North Carolina’s 2023 congressional maps, allowing the redrawn districts to remain in place for upcoming elections. 

• Governor Stein, NCDHHS, and the Governor’s Recovery Office for Western NC (GROW NC) announced the expansion of WNC Thrive. The initiative increases access to after-school programs, weekend activities, mental-health supports, and summer camp opportunities across 22 Western NC counties.

• A New Bern ophthalmologist filed a constitutional challenge to North Carolina’s Certificate-of-Need (CON) law, arguing the regulations violate economic-liberty protections.

• North Carolina remains without a full state budget. The ongoing legislative impasse keeps the state operating under last year’s funding levels, slowing decisions for Medicaid and other priority programs. 

November 10, 2025

• Governor Josh Stein urged NC lawmakers to convene a special session to address shortfalls in funding for Medicaid. The session is scheduled for November 17th.

•  State Treasurer Brad Briner and the State Employees Association of NC (SEANC) filed court documents in support of a lawsuit challenging the state’s certificate-of-need health care restrictions. A court hearing is scheduled for November 18th.

• The NC Department of Health and Human Services (DHHS) announced that partial payments were uploaded onto EBT cards for SNAP beneficiaries on Friday, November 7th. 

• The North Carolina Chamber of Commerce and Blue Cross and Blue Shield of North Carolina announced the Carolina HealthWorks program, a new health insurance plan for small businesses (2-50 employees) who are members of the Chamber or local chambers.

November 3, 2025 - No Update

October 27, 2025

• North Carolina state legislators remain stalled in negotiations on Medicaid. The Charlotte News & Observer reports that lawmakers are unlikely to reach an agreement on Medicaid funding in October. By the time they convene in November, there will be more information about the impact of the October 1st cuts to reimbursement rates.

• The NC Legislature voted along party lines to approve a new congressional map for NC, which would add one new congressional district. The new district increases the number of districts in which Republicans have an advantage from 10 to 11, out of 14 congressional seats in NC. 

• The full NC Legislature re-convenes on November 17th.

October 20, 2025

• The North Carolina State Health Plan's exclusion of coverage for transition-related treatments typically sought by transgender patients was reinstated last Wednesday, after a 4th circuit court vacated a trial judge’s 2022 decision to block the exclusion (Kadel v. Folwell).

• Though there was concern about discontinuation of Supplemental Nutrition Assistance Program (SNAP) benefits, the NC Department of Health and Human Services assured the public that they will continue to be paid in October. The DHHS encourages households to continue to apply.  

• Legislators return to session this week, October 20, 2025. Major issues are the state budget and Medicaid funding. The chambers are in disagreement about the timeline for tax cuts and the establishment of a new children’s hospital. According to the National Conference of State Legislatures, North Carolina is one of two states that has not enacted a budget for the current fiscal year.

October 13, 2025

This past week included:

• Governor Stein and the NC Department of Health and Human Services announced benefits to over 2.5 million North Carolinians after 15 months of a medical debt elimination effort, which came out of the Healthcare Access and Stabilization Program, which was approved by state legislators in 2023.

• Governor Stein proclaimed October 12-17 Health Care Security and Safety Week.

• The NC Department of Health and Human Services is invitinginput on its Rural Health Transformation Plan application to the Centers for Medicaid and Medicare Services . Western North Carolina organizations and individuals may submit input here by October 15th. For reference, the WNC Health Network shared their comments.

• Legislators return to session on October 20, 2025.

October 6, 2025

This past week included:

• The NC Legislature adjourned until late October without the House and Senate agreeing on a Medicaid Rebase bill.  The two chambers passed their own budget bills but did not agree on funding for a UNC Duke Children’s Hospital.

• Medicaid reimbursement rate cuts went into effect:  The North Carolina Department of Health and Human Services (NCDHHS) announced cuts to Medicaid reimbursement rates effective October 1, 2025.

• Governor Stein signed HB 307 (“Iryna’s Law”) into law, recognizing additional measures to review cases and concerns over some aspects of the bill, including the last-minute addition of firing squads as a form of execution. He encourages a comprehensive public safety package.

• The NC Department of Health and Human Services is invitinginput on its Rural Health Transformation Plan application to the Centers for Medicaid and Medicare Services . Western North Carolina organizations and individuals may submit input here by October 15th. For reference, the WNC Health Network shared their comments.

September 29, 2025

Selected WNC-Relevant State Health Policy Updates:

• HB 307(“Iryna’s Law”) was passed by the NC Legislature and went to the Governor on Tuesday 9/23/25. According to a Carolina Journal article, the bill “tightens pretrial conditions for the release of violent offenders, eliminates cashless bail, establishes a new protocol for ordering mental health evaluations in the criminal justice system, and sets a firmer timeline for appeal in death penalty cases.” Critics pointed out that there are no additional funds allocated for mental health evaluations or care.

• Governor Josh Stein announced that starting this week, the state is lowering reimbursement rates to doctors, hospitals, and other healthcare providers, according to an AP News article.

• The NC Department of Health and Human Services is invitinginput on its Rural Health Transformation Plan application to the Centers for Medicaid and Medicare Services . Western North Carolina organizations and individuals may submit input here by October 15th. For reference, the WNC Health Network shared their comments.