FOR IMMEDIATE RELEASE: June 17, 2025 | CONTACT: Brendan Riley, rileyb@ncchca.org  

RALEIGH, NC – The North Carolina Community Health Center Association (NCCHCA) is sounding the alarm following the release of a new study, which reveals that Medicaid work requirements proposed by Congress would cause devastating financial losses to Community Health Centers (CHCs). Today, Community Health Centers provide comprehensive primary care across over 600 clinical locations in 92 counties for over 762,000 North Carolinians, regardless of their ability to pay. Health centers work together with the Medicaid program, which covers 1 in 4 North Carolinians, to keep people healthy and out of emergency rooms, saving money for taxpayers.

According to the new study, North Carolina’s Community Health Centers could face cuts to over 70 percent of their annual Medicaid reimbursements—over $100 million per year—if Congress enacts federal Medicaid work requirements as proposed in the One Big Beautiful Bill Act passed by the U.S. House of Representatives in late May and as proposed just this week by the Senate Finance Committee.

The study highlights that many CHC patients, despite being eligible for Medicaid, would lose their coverage due to administrative barriers under a work requirement system in which their employment or exemptions must be manually documented and verified. In states like Arkansas, similar requirements have led to disenrollment rates as high as 72%, even among those who met the criteria. If North Carolina is required to fast-track implementation of work requirements as proposed by the House bill, an estimated 89,000 health center patients could lose Medicaid coverage due to administrative hurdles. Under the Senate proposal, states would have more resources and could request a longer glide path to develop systems needed to automate some of the requirements, which could reduce some of the paperwork obstacles that would push North Carolinians off their Medicaid coverage.

“The data show that even North Carolinians who are working or exempt from the requirements will still lose their Medicaid coverage under these proposals,” said Chris Shank, President and CEO of NCCHCA. “The administrative burden on local Departments of Social Services—and on Medicaid enrollees alike—to meet new manual, paperwork requirements will result in tens of thousands of health center patients losing Medicaid coverage and becoming uninsured.”

In order to meet their mission, Community Health Centers depend on third party reimbursements for services provided to patients with health coverage. With these projected coverage losses, health centers stand to lose not only revenue from foregone reimbursements, but they face increased costs associated with caring for newly uninsured patients. Federal grant funding for CHCs, another critical revenue source, has been flatlined for a decade despite rising costs and increased demand for services.  All told, the financial strain from these coverage losses could force health centers to reduce services, lay off staff, or close sites—jeopardizing access to care for hundreds of thousands of North Carolinians.

“We urge Congress to reconsider these harmful provisions,” said Shank. “Community Health Centers are a lifeline for underserved communities. These changes would undermine decades of progress in expanding access to care in rural North Carolina.”

Methodology

The findings in this release are based on a new analysis conducted by Capital Link, which models the financial and operational impact of proposed Medicaid work requirements under H.R. 1 on North Carolina’s Community Health Centers. A detailed overview of the methodology can be found in the Methods section of Nearly 5.6 Million Community Health Center Patients Could Lose Medicaid Coverage Under New Work Requirements, with Revenue Losses Up to $32 Billion (Sara Rosenbaum, Feygele Jacobs, and Kay Johnson, To the Point (blog), Commonwealth Fund, May 30, 2025). However, whereas that piece generates state estimates using data from 2023, today’s North Carolina-specific analysis utilizes preliminary data from calendar year 2024, collected from 40 of North Carolina’s 43 Community Health Center organizations, which provides a more accurate financial baseline since North Carolina started implementing Medicaid expansion in December 2023.

Contact

For more information, contact:
Brendan Riley, VP, Government Relations and External Affairs
North Carolina Community Health Center Association
Email: rileyb@ncchca.org | Phone: (919) 469-1116
Website: www.ncchca.org

RALEIGH, N.C., April 16, 2025 – The Carolina Medical Home Network (CMHN) released its request for proposal (RFP) to identify aligned Medicaid health plans to pursue value-based agreement terms that meet the specific needs of federally qualified health center (FQHC) and the complex patients they serve.  The RFP focuses on transparency, efficiency and optimizing disease prevention and reducing the burden of chronic disease for members across the state. The RFP represents the launch of CMHN’s Preferred Payor Arrangement (PPA) Initiative.

NCCHCA is CMHN’s sponsoring and managing partner.

CMHN’s CEO and President, Chris Shank says, “North Carolina’s community health centers form a critical provider network across the state and have joined together through CMHN to fully support our state’s Medicaid program and members. We believe that selecting preferred payor relationships is critical for our health centers and the members we serve to deliver the highest quality preventive, physical, behavioral and dental health care in communities across the 100 counties of North Carolina.”

PPA Features and Goals: Since the launch of Medicaid managed care in 2021 and Medicaid expansion in 2023, the relationship between Medicaid’s Prepaid Health Plans (PHPs) and North Carolina’s FQHCs has continued to grow. CMHN’s member FQHCs provide vital services to over 125,000 Medicaid beneficiaries. At any point in time, North Carolina’s FQHCs ensure healthcare for between 5-10% of Medicaid’s Standard Plan members.

CMHN is offering all NC Medicaid PHPs an opportunity to be a preferred plan by achieving the following mutually beneficial goals:

1. Simplify contracting and reduce administrative burdens for FQHCs
2. Aligning incentives based upon a discrete set of quality measures to allow focused interventions for prevention and chronic disease
3. Achieving network adequacy and patient access for NC residents in every corner of the state including our most rural communities
4. Ensuring sustainability of rural providers to provide integrated primary care, behavioral and oral health care
5. Advancing enhanced access to health and wellness for hard-to-reach populations
6. Improving the value of Medicaid spending while improving member outcomes and quality of life

Timings: The PPA RFP is being sent to all 5 Medicaid PHPs on Wednesday, April 16, 2025. PHP responses are expected no later than June 13, 2025 with plans for CMHN to announce its selected panel of Preferred Payors by August 15, 2025. Payor contract negotiations are expected to be completed no later than October 31, 2025 so that CMHN’s network will be ready to serve Preferred Payor patients on January 1, 2026.

About CMHN: Carolina Medical Home Network is a clinically integrated network comprised of 26 federally qualified health centers serving Medicaid and Medicare patients across the state of North Carolina.  CMHN currently holds payor contracts with all current Medicaid prepaid health plans.

Visit this page for more information and to download the PPA RFP.