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. Two key indicators, the uninsured population and early prenatal care, face significant funding changes under the passage of House Resolution 1 (HR1), the One Big Beautiful Bill Act. With partners like NC Child, the North Carolina Institute of Medicine is exploring possible impacts of federal legislation on child and family health outcomes in North Carolina and what these impacts mean in the latter half of this decade.
When HR1 passed earlier this summer, it came with significant funding cuts to Medicaid. At NC Child, we’ve been keeping an eye on how our state’s decisionmakers are addressing the funding shortfall and new administrative requirements because we know just how much Medicaid matters for our state’s children and families.
But at this moment, we still don’t know exactly how federal Medicaid funding cuts are going to impact North Carolina families. Our leaders are still discussing the options on the table—and each of these options has their own strengths and weaknesses.
When I started at NC Child a few years ago, one of the projects I began working on was our Medicaid storytelling fellowship. Throughout the project, I met parents and caregivers who shared with me their stories of hard choices, sleepless nights, and ultimately, solace. Medicaid played such an intimate role in their lives and had a substantial impact on family well-being.
For Trina, Medicaid was with her throughout her second pregnancy, helping her access and receive prenatal care. “Having already been through one high-risk pregnancy, I want to underscore the anxiety of going through a second. My family was terrified,” says Trina. “But Medicaid was there.”
Trina’s story is not uncommon in North Carolina, where Medicaid covers 50% of all births and 61% of all children [1, 2]. Medicaid is there so that parents can focus on their new member of the family without worrying about choosing between rent and hospital bills.
For Tiffany, a mother of three special needs sons in Rowan County, Medicaid has been an instrumental part of her children’s lives. Her oldest son, a teenager, needs help bathing—and for a long time, there was no shower in the house that could accommodate him. But thanks to Medicaid, Tiffany’s son gained access to a bathroom that fits his needs.
For Gregory, who is the primary caregiver for his five grandchildren, Medicaid has helped the family access educational services so they can achieve in school. In our state, 54% of children with special education plans are covered by Medicaid [4].
For all of the essential services that Medicaid has provided families like Trina’s, Tiffany’s, and Gregory’s, many caregivers have also experienced hardships around the program.
For Hannah, her son was on a waiting list to receive a Medicaid Innovations waiver. “For 12 years, we waited for his name to rise on the waiver list. In the interim, Medicaid provided basic services, but it wasn’t enough to meet his unique needs,” says Hannah.
Through every appointment and every sleepless night, Hannah steeled her resolve. She did her research and was able to see some improvement as she worked with her son. “When we finally got the waiver, he was able to get a device to assist him with speech and communication. It made a world of difference in our lives.”
Medicaid isn’t perfect—but then again, nothing ever is. At its core, however, Medicaid is about care. “Medicaid is built to assist those who need it. It’s a great benefit that, if used correctly and administered with families in mind, it helps all of us—and our communities—be healthy and thrive,” says Hannah.
This qualitative data from our storytellers is important, as it gives us a nuanced understanding of how Medicaid policy translates into practice.
Now let’s look at some of the quantitative data.
A 2025 report from the Georgetown University Center for Children and Families found that nearly 49% of children in North Carolina’s small towns and rural areas rely on Medicaid/CHIP for their coverage. This is 8 percentage points higher than the national average [5].
Economic stress is often associated with high rates of abuse, and children living in low-socioeconomic status households are three times more likely to be abused. Having health coverage both reduces financial stress and encourages health services utilization, both of which have lasting impacts on a child’s own health and well-being [6].
For children below the age of six, the improved familial financial stability that comes with Medicaid expansion is associated with a significant decline in child neglect [7].
Some studies also suggest that Medicaid expansion leads to decreases in foster care admissions [8]. Child abuse is one of the leading factors associated with foster care admissions; about 70% of all foster care admissions are associated with some level of abuse or neglect incidents.
The Georgetown University Center for Children and Families also reports that Medicaid has been linked to larger decreases in maternal and infant mortality, with some studies linking expansion to decreases in preterm or low birthweight and postpartum hospitalizations [9].
With continuous Medicaid health coverage, mothers can access the care they need before, during, and after pregnancy. This means access to check ups and screenings, prenatal care early on in pregnancy, and timely treatment that improves the chances of delivering a healthy baby [10].
When we invest in and protect Medicaid access, our children and families have more positive health and economic outcomes—and we can see the strength of these outcomes reflected in the data and in the stories of North Carolinians. While the specific decisions for NC Medicaid’s future are still in flux, it’s up to us to keep childhood outcomes at the center of these conversations and to make their health and well-being our priority.
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Written by Guest Author
Emily Blevins
Communications Director, NC Child
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