Comunidad de Hertford se moviliza contra posible reapertura de centro de detención del ICE en Winton
Miembros de la comunidad del condado de Hertford, Carolina del Norte y defensores de los derechos de los inmigrantes llevarán a cabo una protesta pacífica para manifestarse en contra de la posible reapertura de un centro de detención del ICE.
Amid rising costs and the expiration of enhanced subsidies, fewer North Carolina residents enrolled in health coverage under the Affordable Care Act for 2026, according to the latest figures from the Centers for Medicare & Medicaid Services.
What is ACA Coverage and why do people use it?
Signed into law in 2010 by then-President Barack Obama, the Affordable Care Act expanded health care coverage for millions of Americans.
The law created tax credits to help lower out-of-pocket costs. It also barred insurers from charging people with pre-existing health conditions higher premiums or denying coverage altogether.
Since its passage, the ACA, also known as Obamacare, has survived several legal challenges and attempts by Republican lawmakers to repeal it.
How many people enrolled in health coverage under the ACA in North Carolina for 2026?
Just 761,457 people enrolled in health coverage under the ACA in North Carolina for 2026, according to the latest figures from the Centers for Medicare & Medicaid Services. The decline is about 22 percent, or 214,000 fewer enrollments, than in 2025, the largest percentage drop in the country.
Nationally, less than 23 million people enrolled in health coverage under the ACA for 2026, according to CMS data. In 2025, more than 24 million enrolled.
Enhanced tax credits that went into effect during the pandemic expired at the end of the year. Those tax credits, which were at the center of the longest government shutdown in history, did two things to help individuals who needed health insurance coverage:
They increased the financial assistance ACA enrollees received when purchasing coverage on the Health Insurance Marketplace.
They expanded eligibility to people earning more than 400 percent of the federal poverty level.
Additionally, the federal government’s steep cuts to the ACA navigator program, which educates consumers on marketplace coverage and other coverage options, likely led to fewer enrollments in North Carolina.
Nicholas Riggs, the director of the NC Navigator Consortium, a statewide network of health insurance navigators, told NC Local there was high demand for appointments with navigators during open enrollment given the cost increase and confusion around subsidies. Navigators even ran out of availability.
“Our whole goal is to provide unbiased assistance for folks and help people explore the marketplace and provide high quality care and assistance for folks,” Riggs said. “When we’re not able to do that, it’s frustrating for all of us, especially for those that we serve.”
Will more people in North Carolina lose ACA coverage?
This year, most people are paying more for the same health care coverage, Riggs said, while many chose higher-deductible plans to lower their monthly premium. Others did not enroll in coverage at all, Riggs added.
Meanwhile, some consumers enrolled in hopes that Congress would ultimately extend the now-lapsed enhanced subsidies.
“Based on some of the conversations that we had, some folks are saying, ‘Well, I’m going to see what happens with the subsidies. If they’re not extended, I don’t know if I can pay this premium every month,’” Riggs said. “So, we expect that there will be a good number of folks who drop off after this month who just aren’t able to pay their premiums.”
Earlier this year, there were talks to extend enhanced premium subsidies, but any momentum behind an extension appears to have waned.
Who is most affected?
Some professions rely more heavily on individual coverage, such as chiropractors, musicians, real estate agents, farmers and dentists, according to KFF. In each of these industries, at least one-fourth of professionals nationwide get their coverage through the individual market.
Some professional associations are providing plan options for their members. For example, NC Realtor, a trade association for thousands of realtors, offers Anthem health care plans for purchase by members. The NC Dental Society also offers plan options for members.
KFF Health News also recommends discussing financial options with your medical provider and looking for cost-saving measures on prescription drug expenses.
“Immigrant population generated more in taxes than it received in benefits,” study finds
A recent national study analyzing 30 years of fiscal data clearly shows that immigrants have contributed more to the country than they have received, helping sustain public budgets and avert a debt crisis in the United States.
Medicaid’s retroactive safety net is shrinking — patients, hospitals could feel the fallout
By Jaymie Baxley
When people qualify for Medicaid after a medical emergency, the program can currently reach back up to three months to pay for care they received before they applied — a safeguard that often prevents a hospital stay or ambulance ride from turning into lifelong debt.
That protection is about to shrink.
Beginning in January 2027, federal changes will sharply limit how far back Medicaid can cover medical bills for newly approved enrollees.
For adults covered under Medicaid expansion — a group that now includes more than 700,000 North Carolinians — retroactive coverage will drop from three months to just one. Other Medicaid populations, including children, seniors and people with disabilities, will see the window reduced to two months.
State officials say the changes are largely outside North Carolina’s control, but consumer advocates, legal aid attorneys and hospital groups warn that the shorter timeline could leave patients and providers burdened by costs that Medicaid would previously have covered.
How retroactive coverage works — for now
Sarah Gregosky, chief operating officer for NC Medicaid, said the current rules allow people applying for Medicaid to request coverage for medical services they received before submitting their application, as long as they were qualified at the time they received care.
When an applicant requests retroactive coverage, the state reviews their eligibility month by month — both prospectively and retroactively — which can result in Medicaid paying claims for care that occurred as much as 90 days before the person ever realized they qualified.
“What’s going to happen is the periods in which we’re reviewing retrospectively, when folks indicate on their application, is going to shorten,” Gregosky said. “For our traditional Medicaid programs, […] folks will have a 60-day period that they can say, ‘Hey, I had medical claims. Can you review my eligibility in those months?’ And for our expansion population, it will be limited to the 30 days prior to eligibility.”
Gregosky said the state has little flexibility in how the change, part of the One Big Beautiful Bill Act signed into law last summer by President Donald Trump, is implemented.
“It’s largely prescribed by federal rules,” she said. “We don’t have discretion in extending that period.”
A safety net in case of emergency
Retroactive coverage is most commonly used by people who only realize they qualify for Medicaid after something goes wrong — a hospitalization, accidental injury or sudden illness that forces them into the health care system.
“Typically, folks who are looking for that retrospective coverage had some sort of event that is triggering them to apply,” Gregosky said.
(The N.C. Department of Health and Human Services was unable to provide NC Health News with data for how many retroactive claims are submitted and approved each year.)
Health care navigators who help people enroll in Medicaid say the three-month window has been crucial since North Carolina expanded the entitlement program to cover more low-income adults in 2023.
“That three months retroactive coverage has been a big lift for a lot of people who really need emergency services, [who] go in and are hospitalized for a certain amount of time and are not able to enroll before that,” said Nicholas Riggs, director of the NC Navigator Consortium. “Or they had some sort of life change or experience and just haven’t had a chance to get coverage.”
Riggs said navigators regularly work with people who assumed they weren’t eligible for Medicaid until a health crisis forced the issue.
That’s especially true, he said, for people who qualify through expansion, which raised the state’s strict income threshold for Medicaid. The measure opened up the program to many working adults with lower incomes who previously made too much money to qualify.
“A lot of folks deem that they’re ineligible for coverage, when the contrary is true,” Riggs said. “They would have been eligible the whole time.”
With less time for coverage to be applied retroactively, Riggs said even small delays or misunderstandings during the application process could carry far greater consequences for patients who qualify for Medicaid but don’t realize it until after an emergency.
“My biggest advice to folks is don’t wait to enroll,” he said. “If you have any change in eligibility, even if you don’t think that you’re eligible for coverage, try to enroll because you never know.”
The looming changes come as enrollment assistance resources are thinning. Riggs said federal funding cuts forced the NC Navigator Consortium to reduce its staff by about 25 percent last year, which limited the group’s capacity to help people understand their eligibility and complete applications.
“We are worried about being able to reach the number of people that we were before with so many policy changes going into effect,” he said, adding that the state’s need for navigators “has never been more critical.”
Less room for mistakes
Attorneys at Pisgah Legal Services, a nonprofit law firm serving western North Carolina, are anticipating an increase in clients facing medical bills they would previously have been able to resolve through retroactive Medicaid coverage.
“If you’re not navigating eligibility and not navigating these systems and seeing what goes wrong, you could think, ‘Well, what’s the big deal between one month and three months?’” said Thomas Lodwick, a managing attorney at the firm who specializes in cases concerning health and income. “But the big deal is that stuff goes wrong all the time. Applications get lost. They get erroneously denied.”
Lodwick said the existing three-month window acts as a “buffer,” giving applicants time to identify and fix issues that might otherwise derail their enrollment after an expensive emergency.
“Even if something goes wrong the first time [they apply], you can kind of clean it up and get them covered for that same period, and then they can avoid a crushing medical debt,” Lodwick said. “Frankly, a lot of times it can take months for that initial application to get processed or for the person to even find out that they were denied.”
With that buffer shrinking, Lodwick said the financial consequences will not stop with patients.
“Realistically, if you’re visiting the ER in an ambulance and you’re someone who qualifies for Medicaid, you’re not going to be able to pay these thousands and thousands of dollars,” he said. “At some point, that means the hospitals and other emergency service providers are going to be providing uncompensated care, further straining their abilities to provide care to everyone.”
Shortened retroactive coverage, he added, “affects everybody who wants hospital or ambulance services that are well-funded and running as well as they can be.”
Hospitals brace for higher unpaid bills
When North Carolina became the 40th state to expand Medicaid in 2023 (Washington, D.C., has also expanded), lawmakers imposed a special tax on hospitals to help offset the cost of covering hundreds of thousands of newly eligible residents.
It was a worthwhile tradeoff for hospitals, which saw significant reductions in uncompensated care as more patients gained health insurance.
But advocates and hospital groups say the reduction in retroactive Medicaid coverage threatens to shift some of those costs back onto providers — particularly when patients qualify for Medicaid but miss the narrower retroactive window.
In a statement to NC Health News, the North Carolina Health Care Association said the changes are “likely to create additional administrative challenges” for the more than 130 hospitals it represents across the state.
“There is also a heightened risk of uncompensated care during potential administrative gaps,” an association spokesperson said. “Hospitals that serve a higher percentage of low-income individuals may feel these impacts more acutely, with smaller, community hospitals facing a disproportionate burden.”
Uncompensated care costs have contributed to the closure of nearly 200 financially struggling hospitals in rural communities across the United States. At least 12 rural hospitals in North Carolina have shuttered since 2010, according to data from the Cecil G. Sheps Center for Health Services Research at UNC Chapel Hill.
Cuts collide with other changes
Navigators and legal aid attorneys worry that the loss of retroactive coverage comes at the worst possible moment — just as new work requirements and reporting rules increase the risk of coverage lapses that people may not discover until they need emergency care.
“This is just another thing that we need to make sure that folks are aware of as they apply,” Gregosky said. “There’s a lot of changes that are going to happen for beneficiaries.”
The One Big Beautiful Bill law also introduces a federal work requirement for Medicaid. Beginning Jan. 1, 2027, many beneficiaries will be forced to prove they are working, volunteering or attending school for at least 80 hours a month to maintain benefits.
Advocates fear the work requirement will result in an untold number of beneficiaries losing coverage — not due to unemployment, but paperwork issues.
Most of the enrollees who will be subject to the requirement, which applies only to expansion beneficiaries, already have jobs, according to the N.C. Department of Health and Human Services. But technological limitations, language barriers and other challenges could prevent many from regularly submitting the documentation needed to confirm their employment status.
Lodwick said even brief lapses caused by missed notices, processing delays or confusion over the new rules could leave people uninsured when an emergency strikes, with fewer options to retroactively fix the problem afterward.
“You could be cut off and not know it, and then find out when you end up in the emergency room,” he said. “I think there are a lot of us who kind of use health care as needed and, fortunately, don’t need it very often. But then when you do, you really need that retro coverage to get you back on.”
