Healthy North Carolina 2030 (HNC 2030) identifies key public health indicators for our state. The State Health Improvement Plan has engaged statewide leaders in ongoing efforts to improve the health of North Carolinians through policies, programs, and systems related to these health indicators. The North Carolina Institute of Medicine is exploring possible impacts of federal legislation on cancer care and outcomes in North Carolina and what these impacts mean in the latter half of this decade.
In 2025, House Resolution 1, or the One Big Beautiful Bill Act (OBBBA, HR1) was passed by Congress and signed into law, enacting major changes to Medicaid funding. The bill seeks to limit the amount of federal Medicaid support each state receives to administer care [1]. These reductions could have significant implications for health care access in North Carolina, particularly for those dependent on Medicaid for critical health services. Medicaid plays a critical role in providing cancer treatment for low-income and vulnerable populations, and reductions in funding could limit access to essential care. It is important to examine the potential consequences of these federal changes on cancer treatment, using insights from the Healthy North Carolina 2030 report, which provides an updated framework for improving health outcomes over the next decade.
Medicaid is a vital resource for North Carolinians with cancer, covering treatment services, screenings, and supportive care for those who may be uninsured. Eligibility for Medicaid in North Carolina depends on an individual’s income, age, disability, and other factors, as outlined by the North Carolina Department of Health and Human Services [2]. North Carolina also administers the Breast and Cervical Cancer Medicaid (BCCM) program, which provides coverage for uninsured or underinsured patients diagnosed with breast or cervical cancer. This program ensures treatments such as surgery, chemotherapy, and follow-up cancer care for patients who may not qualify for traditional Medicaid coverage [3]. The state’s recent expansion in December 2023 [4] has increased accessibility for low-income families to cancer care, which could lead to measurable improvements in cancer outcomes [5].
Reduced Medicaid funding could have multiple downstream effects on cancer care, such as limited access to treatment, increased out-of-pocket costs, and reduced provider participation. Fewer low-income patients may qualify for Medicaid, creating barriers to necessary treatment such as chemotherapy, radiation, or surgical intervention. Patients losing coverage may also face higher personal expenses, which could delay treatment and reduce adherence to care plans, worsening outcomes. However, the impact is not just limited to patients since health care providers also risk lower reimbursement rates, which may prompt some oncology practices to reduce Medicaid participation or limit services, further reducing access for vulnerable populations [6].
To understand how these federal changes could shape cancer outcomes, it’s helpful to examine state-level data through Healthy North Carolina 2030 (HNC 2030) indicators. The HNC 2030 report, developed by the North Carolina Institute of Medicine and the Department of Health and Human Services, outlines 21 key indicators that track the state’s progress towards better health outcomes and health equity by the year 2030 [6]. These indicators discuss factors such as health behaviors, clinical care, social and economic factors, and the physical environment that influence overall well-being. By using these measures, policymakers and health organizations have been assessing how policy changes such as Medicaid funding may impact the state’s health system. Several of these indicators demonstrate how federal changes to Medicaid could directly impact cancer prevention, diagnosis, and treatment outcomes in North Carolina.
Health Indicator 16: Uninsured Rate. This health indicator demonstrates the need for access to comprehensive and affordable health care in order to achieve good health outcomes. Health insurance is the most common means of obtaining good care, and those without or with reduced coverage are more likely to delay or entirely sacrifice preventative services, experience chronic conditions, and face financial hardship due to medical costs. Certain populations in North Carolina are disproportionately uninsured, such as workers in seasonal or service-based industries who often lack access to employer-sponsored coverage. Rural residents also face higher uninsured rates compared to those in urban areas due to lower job availability and fewer health care options. Racial and ethnic disparities are also present: Hispanic residents experience disproportionately high uninsurance rates due to employment barriers and eligibility restrictions for public programs [7]. Medicaid cuts could perpetuate these inequities in care. Reducing funding limits eligibility, which is especially a risk for newly enrolled populations under expansion.
Health Indicator 17: Primary Care Workforce. Access to health care providers is another major determinant of cancer outcomes, as reflected in Health Indicator 17: Primary Care Workforce from HNC 2030. This indicator demonstrates how providers are a critical component for prevention, diagnosis, and care coordination. When access to primary care is limited, preventative screenings decline, leading to later-stage diagnoses and poorer outcomes. Primary care is responsible for routine screenings, which are essential for early detection. However, access to primary care remains uneven across socioeconomic groups in North Carolina, where 38 counties do not meet the recommended ratio of providers to residents; this is especially prevalent in underserved and rural communities. Although North Carolina’s primary care workforce has significantly grown, rural areas continue to face shortages due to recruitment challenges and limited infrastructure. While the recommended 1500:1 population-to-primary-care-clinician ratio was met in 80 North Carolina counties in 2024, every county with the most extreme shortages (>3000:1) is rural and located in the northeastern region of the state [8]. As a result, these areas have fewer training opportunities, fewer incentives to practice, and weaker infrastructure. Nationwide trends also influence this imbalance, since fewer medical graduates choose primary care due to the high cost of medical education and lower income compared to specialty fields [9].
Health Indicator 2: Life Expectancy. After steady growth in the life expectancy rate, there has been a slight decrease in recent years, driven mainly by drug overdoses and suicides. According to Health Indicator 2: Life Expectancy, North Carolina demonstrates that the state’s average life expectancy slightly decreased from 78.3 to 78.0 between 2014 and 2018. Studies have identified that ischemic heart disease and lung cancers are major candidates for propagating this decrease, and their occurrence is most evident in racially and geographically marginalized communities [10, 11]. Although a quantitative measure, life expectancy rates capture important information about how different communities live and die differently based on their demographic. The data highlights how prevention, equitability, and community health matter.
Over 66,000 individuals in the North Carolina Medicaid expansion population needed a cancer screening in 2022 [12]. However, analyses estimate that reductions in Medicaid funding could leave fewer patients with access to treatment, potentially increasing cancer mortality rates in the state. In other states with Medicaid cuts, patients have reported delays in treatment initiation, reduced adherence, and increased financial hardship. For example, in states like Arkansas where Medicaid work requirements were implemented in 2018, studies show a 4.4% increase in the uninsured rate among adults aged 30–49 and evidence of poorer medication adherence and delays in care among those who lost coverage [13, 14]. Additionally, policy analyses indicate that future federal work-reporting mandates and funding reductions could reduce federal Medicaid funding by hundreds of billions of dollars over the next decade, with a projected five million adults losing coverage if states impose these requirements [15, 16].
Federal changes to Medicaid funding have the potential to significantly affect cancer treatment access in North Carolina, particularly for low-income populations. By examining the evidence through resources like the Health North Carolina 2030 indicators and their levers for change, it becomes evident that reduced coverage could increase uninsured rates, limit primary care services, and ultimately lead to downstream effects on overall life expectancy. Equitable access to cancer care means ensuring that every patient regardless of income, race, or geography can obtain early detection through routine screenings, receive affordable treatment, and access follow-up or supportive care without financial barriers. Achieving this requires evidence-based recommendations, such as expanding coverage, strengthening community health networks, and increasing provider accessibility, which are all necessary strategies for improving statewide health outcomes. Together, these levers emphasize that maintaining and expanding Medicaid funding is essential for both equitable access to cancer care and achieving North Carolina’s broader public health goals.
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Written by
Roshni Arun
Editorial Fellow, NCMJ
This blog post is part of a NCIOM blog post series to explore the impacts of federal policy changes on Medicaid funding and key health indicators from the Healthy North Carolina 2030 framework.
What Medicaid Cuts Mean for NC Children and Families (November 17, 2025)
Federal Changes to Food Assistance in North Carolina (September 15, 2025)
Drug Overdose Trends in North Carolina and Potential Impacts of the One Big Beautiful Bill Act (OBBBA) (August 25, 2025)
Impacts of Changing Federal Policy on Insurance Rates and Access to Primary Care (July 31, 2025)
Primer: Understanding Private Health Insurance in North Carolina (December 30, 2025)
Primer: Understanding Medicare in North Carolina (December 30, 2025)
Primer: Understanding Medicaid in North Carolina (December 30, 2025)
1. H.R.1 – One Big Beautiful Bill Act: https://www.congress.gov/bill/119th-congress/house-bill/1/text
2. North Carolina Medicaid Eligibility. NC Department of Health and Human Services: https://medicaid.ncdhhs.gov/eligibility
3. Breast and Cervical Cancer Medicaid Program. NC Department of Health and Human Services: https://bcccp.dph.ncdhhs.gov/BCCM.htm
4. North Carolina expanded health care coverage to more people. NCDHHS: https://medicaid.ncdhhs.gov/north-carolina-expands-medicaid
5. Medicaid Expansion in North Carolina. Associated Press: https://apnews.com/article/638d37069e0193dc86d46c23c18f9c00
6. Impact of Medicaid Cuts on Cancer Treatment Access. Washington Post: https://www.washingtonpost.com/health/2025/08/17/north-carolina-medicaid-cuts/
7. North Carolina Institute of Medicine. Healthy North Carolina 2030: A Path Toward Health. North Carolina Institute of Medicine; 2020. https://nciom.org/healthy-north-carolina-2030-a-path-toward-health/
8. Unpacking the Primary Care Clinician Index: Understanding How Changes in Population and Workforce Supply Affect Access to Primary Care in North Carolina: https://ncmedicaljournal.com/article/146069-unpacking-the-primary-care-clinician-index-understanding-how-changes-in-population-and-workforce-supply-affect-access-to-primary-care-in-north-caroli
9. Cancer in rural America: Improving access to clinical trials and quality of oncologic care. https://pmc.ncbi.nlm.nih.gov/articles/PMC12223359/
10. Disparities in chronic ischemic heart disease-related mortality across sex, race, and urbanization status in the United States, 1999–2019: https://pmc.ncbi.nlm.nih.gov/articles/PMC12425309/
11. Disparities in Lung Cancer: A Targeted Literature Review Examining Lung Cancer Screening, Diagnosis, Treatment, and Survival Outcomes in the United States: https://pmc.ncbi.nlm.nih.gov/articles/PMC11101514/
12. Preventative Care Needs of the North Carolina Medicaid Expansion Population. AJPM FOCUS: https://www.ajpmfocus.org/article/S2773-0654(24)00107-X/fulltext
13. New Evidence Confirms Arkansas’s Medicaid Work Requirement Did Not Boost Employment: https://www.urban.org/urban-wire/new-evidence-confirms-arkansas-medicaid-work-requirement-did-not-boost-employment
14. Pain But No Gain: Arkansas’ Failed Medicaid Work-Reporting Requirements Should Not Be a Model: https://www.cbpp.org/research/health/pain-but-no-gain-arkansas-failed-medicaid-work-reporting-requirements-should-not-be
15. Potential Impact of Federal Changes on State Healthcare Programs: https://shvs.org/resource/potential-impact-of-federal-changes-on-state-healthcare-programs/
16. How Work Requirements Would Affect Medicaid Coverage in Each Expansion State: https://www.rwjf.org/en/insights/our-research/2025/04/how-work-requirements-would-affect-medicaid-coverage-in-each-expansion-state.html