North Carolina facing new federal Medicaid reporting requirements

By Zamone Perez

North Carolina must adopt the federal government’s new work requirement rules for Medicaid within six months, a move policy opponents say will add bureaucracy and hurt vulnerable communities.

Most adults ages 19 to 64 will have to complete 80 hours of work, education, job training or community service to be eligible for benefits. The requirements are part of H.R. 1, President Donald Trump’s budget bill that passed last year.

Maddie Twomey, communications director for Protect Our Care, said many people are at risk of losing Medicaid benefits if they can’t keep up with complex paperwork. She said states will have to take extra steps to ensure people can receive benefits.

“When you think about people who, maybe English isn’t their first language, they might not have steady internet access, people working multiple jobs, it’s very, very easy to fall through the cracks and lose their Medicaid coverage,” Twomey said.

Officials with the Centers for Medicare and Medicaid Services argue the work requirements will help Americans build skills and reduce poverty. On Monday, the agency authorized $200 million in grants to help states modernize their administrative systems as it sets up a framework for putting the policy in place.

Across North Carolina, more than 3 million people were enrolled in Medicaid as of April 2025, representing nearly 30% of the population.

Twomey criticized the requirements as a way to spend less on medical care for low-income people and give major tax breaks to the wealthy few. She urged North Carolinians to hold lawmakers who supported the requirements accountable in the November midterms.

“I think there is an accountability measure here, where we need to make sure we know who is fighting for our healthcare and who is working to rip it away to benefit billionaires and big corporations,” Twomey said.

Certain people are exempt from the rules, including pregnant or postpartum women, people with disabilities, the medically frail, Indigenous enrollees and caregivers of children younger than age 14.

According to the law, federal Medicaid work requirements must be implemented by Jan. 1, 2027.

This story was originally published by Public News Service.