13-07-2025
Opinion: Trump budget bill would end health insurance for 650K North Carolinians
With the health care landscape facing significant shifts, there has never been a more important time to expand consumer-directed health care services. As policymakers consider changes that could reshape Medicaid, potentially reducing federal support by $793 billion over the next decade, states like North Carolina have a unique opportunity to lead with innovation and compassion. By expanding consumer-directed services, we can empower individuals to make choices that best suit their needs, even in the face of fiscal challenges.
One in four North Carolina residents are enrolled in Medicaid. This program for lower-income individuals not only provides health care, but also funds nursing homes and long-term services and supports that are required by people with disabilities or who are aging in place. Through Medicaid expansion, North Carolina was able to offer support to more people with disabilities and people who are 65 or older. These individuals account for 23% of Medicaid enrollees. They, like thousands of others, are fearful of how their health and wellbeing may be impacted in light of proposed Medicaid changes.
The bill currently being discussed in the U.S. Senate has provisions that may jeopardize enhanced federal matching funds for Medicaid expansion, which could immediately end health insurance coverage for the more than 650,000 North Carolinians who benefit from Medicaid expansion. Overall, North Carolina could face federal Medicaid funding cuts of $32 billion over the next decade, but the state has the chance to protect and uplift those who rely on Medicaid by investing in flexible, person-centered solutions that put people in charge of their support. North Carolina's consumer-directed care programs include person-centered planning and budget management, which promote greater independence, higher satisfaction, and better health care outcomes for participants.
If Medicaid is not protected, the proposed cuts may put valuable consumer-direction programs and the people they serve at increased risk. Programs like Community Alternative Program for Children and Disabled Adults and Coordinated Caregiving enable participants to hire family members or other trusted caregivers, reduce administrative overhead, and avoid unnecessary or institutional services. People can safely stay in their homes and communities rather than in high-cost settings like hospitals or nursing facilities
With the aid of financial management service providers, individuals in consumer-direction programs have support in navigating the details that come with becoming an employer. An FMS helps manage payroll, taxes and budgets, and can provide guidance when it comes to hiring, supervising, and even firing personal care assistants. It also provides an extra layer of accountability, helping ensure compliance with a program's rules. With this behind-the-scenes support, individuals can focus on what matters most: their health, autonomy, and quality of life.
The person-centered approach of consumer-directed programs leads to more efficient use of Medicaid funds and long-term savings. While institutional care costs generally exceed $90,000 per year, similar home and community-based services — such as homemaker services and home health aide services that are often consumer directed in programs like CAP/C, CAP/DA, and Coordinated Caregiving — cost approximately $68,000 annually, as tracked by Genworth's Cost of Care survey.
Proposed cuts that impact Medicaid funding formulas raise concerns that North Carolina could resort to reduced services to make the math work. Some options to accommodate reduced funding could include changing eligibility requirements, making it more difficult for people to participate in a program; reducing provider payments; and revisiting benefits and services to reduce or eliminate some items currently covered. For individuals, they may see authorized budgets fall, which would likely have knock-on effects, from reducing a caregiver's employment hours or pay rate to limiting access to the vital supports to maintain independence and quality of life.
Proposed changes to Medicaid are not yet certain, and North Carolinians still have time to make their voices heard. The state should continue to look to its proven solution of consumer-direction to serve more people who need long-term services and supports. Even more individuals could be supported at a lower cost, less restrictive, more comfortable settings, and for those looking ahead to future care needs, the North Carolina Department of Health and Human Services is the place to start for consumer-direction information.
Home and community-based services funded by Medicaid are not a luxury. They are a core strategy for delivering high-quality, cost-effective, medically necessary, and critical care for North Carolina's most vulnerable populations in a way that allows for choice and control.
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Terrasel Jones is a Director of Operations for GT Independence, a financial management service provider that supports people choosing consumer-direction in North Carolina.
This article originally appeared on Asheville Citizen Times: Opinion: Trump budget cuts funds for Medicaid and most vulnerable
