North Carolina Cuts Medicaid Rates Across the Board

North Carolina Cuts Medicaid Rates Across the Board

Effective October 1, North Carolina is cutting Medicaid payment rates 3-10% across providers.

State leaders cited a budget shortfall and the recently enacted One Big Beautiful Bill Act.

The deepest cuts will impact autism and disability services.

Why it matters 

Medicaid already pays service providers rates far below those of Medicare. 

Budgetary pressures will increase that tension and raise questions about the sustainability of access to care.

Strategic implications

Anticipation of impacts like this was part of what led Senator Thom Tillis (R-NC) to oppose OBBBA and not seek re-election.

10% cuts to residential services and autism therapy are likely to impact already strained services.

What first movers are doing

Providers can prep to brief policymakers by stress-testing their payer mix to identify vulnerability and viability.

Forward-thinking Medicaid directors are contingency planning; child welfare agency leaders are already asking to be at that table.

What to watch

Whether this spreads beyond North Carolina and how rate reductions impact provider sustainability and patient access.