NC Medicaid Cuts Threaten Home Care Access, Leaving Vulnerable Residents at Risk

RALEIGH, NC – October 31, 2025 – A funding shortfall in North Carolina’s Medicaid program is triggering rate cuts to home care services, leaving vulnerable residents facing reduced access to essential support and prompting outrage from advocates. The cuts, implemented October 1st, come after the state legislature failed to fully fund a requested “rebase” – an annual adjustment accounting for enrollment changes and rising care costs – leaving a $319 million gap.

The Human Cost of Reduced Care

The impact of these cuts is felt acutely by those relying on home care – individuals with disabilities, chronic illnesses, and the elderly. For many, these services are the difference between remaining in their homes and entering costly institutional care. “It’s terrifying,” said one anonymous family member whose quadriplegic relative depends on daily nursing visits. “We’re already worried about being able to afford the care he needs, and these cuts just add another layer of stress.” The family fears the reduction in hours will force them to shoulder more responsibility, potentially impacting their own jobs and well-being.

Beyond the immediate financial strain, advocates are concerned about the quality of care. Home care agencies, already grappling with staffing shortages and low wages, are now facing reduced reimbursement rates, forcing them to make difficult choices. Some agencies may be forced to limit the number of clients they serve, while others may struggle to retain qualified staff. “We’re seeing CNAs leaving for higher-paying jobs,” explained a representative from a regional home care association. “These cuts are exacerbating an existing crisis in the workforce.” The cuts range from 3-10% and impact a wide variety of care including skilled nursing, personal care, and specialized therapies for conditions like autism.

Political Battlegrounds: A State Budget in Crisis

The current Medicaid shortfall is the culmination of years of budget battles and competing priorities. While state officials acknowledge the need to expand access to healthcare, disagreements over funding levels and spending priorities have repeatedly stalled progress. The Governor’s office maintains that the legislature failed to adequately fund the Medicaid rebase, forcing the state to implement the cuts to balance the budget. However, legislative leaders accuse the Governor of manufacturing a crisis and contend that sufficient funds were available. “The state has the resources to cover these costs, but the administration has chosen to prioritize other spending,” stated one anonymous state senator.

The situation is further complicated by the recent expansion of Medicaid in North Carolina, which has added hundreds of thousands of new beneficiaries to the program. While expansion is seen as a positive step towards improving access to care, it has also increased the financial burden on the state. The influx of new beneficiaries requires additional funding, and disagreements over how to allocate resources have fueled the ongoing budget debate. This isn’t a new issue, however, historical data shows the state previously operated within budget for several years, maintaining cash-on-hand through FY2019. The previous stability is now threatened.

The Future of Home Care: A System Under Strain

The current crisis raises serious questions about the long-term sustainability of the home care system in North Carolina. The workforce is aging, recruitment is lagging, and reimbursement rates are failing to keep pace with rising costs. This combination of factors is creating a perfect storm, threatening the ability of the system to meet the growing demand for home care services. Some analysts predict that unless significant changes are made, the system will face a critical shortage of caregivers in the coming years. One expert estimates a 10-15% shortfall within five years, driven by both demographic shifts and inadequate funding.

Advocates are calling for a comprehensive solution that addresses the root causes of the crisis. This includes increasing reimbursement rates for home care services, investing in workforce development programs, and expanding access to affordable childcare for caregivers. They also emphasize the need for a more collaborative approach between the legislature, the Governor’s office, and stakeholders in the healthcare community. The state previously enjoyed a period of stability in its healthcare budget, and a return to that stability requires addressing the current challenges comprehensively. “We need to recognize that home care is not just a cost, it’s an investment in the health and well-being of our citizens,” said one advocate. “If we fail to invest in home care, we’ll end up paying far more in the long run for institutional care and emergency room visits.”

As the situation unfolds, the future of home care in North Carolina remains uncertain. The cuts implemented October 1st are just the latest challenge facing a system already under strain. Without a concerted effort to address the underlying issues, the state risks losing a vital safety net for its most vulnerable residents.