Nueva clínica ofrecerá atención médica y apoyo legal a migrantes en el oeste de Carolina del Norte
Con el objetivo de responder a la falta de acceso a servicios de salud, la organización Vecinos en el oeste de Carolina del Norte inaugurará una clínica que brindará atención médica gratuita para personas de bajos recursos y sin importar el estatus migratorio.
Slim margins, climate disasters, and Trump’s funding freeze: Life or death for many US farms
When the Trump administration first announced a freeze on all federal funding in January, farmers across the country were thrust into an uncertain limbo.
More than a month later, fourth-generation farmer Adam Chappell continues to wait on the U.S. Department of Agriculture to reimburse him for the $25,000 he paid out of pocket to implement conservation practices like cover cropping. Until he knows the fate of the federal programs that keep his small rice farm in Arkansas afloat, Chappell’s unable to prepare for his next crop. Things have gotten so bad, the 45-year-old is even considering leaving the only job he’s ever known. “I just don’t know who we can count on and if we can count on them as a whole to get it done,” said Chappell. “That’s what I’m scared of.”
In Virginia, the funding freeze has forced a sustainable farming network that supports small farmers throughout the state to suspend operations. Brent Wills, a livestock producer and program manager at the Virginia Association for Biological Farming, said that nearly all of the organization’s funding comes from USDA programs that have been frozen or rescinded. The team of three is now scrambling to come up with a contingency plan while trying not to panic over whether the nearly $50,000 in grants they are owed will be reimbursed.
“It’s pretty devastating,” said Wills. “The short-term effects of this are bad enough, but the long-term effects? We can’t even tally that up right now.”
In North Carolina, a beekeeping operation hasn’t yet received the $14,500 in emergency funding from the USDA to rebuild after Hurricane Helene washed away 60 beehives. Ang Roell, who runs They Keep Bees, an apiary that also has operations in Florida and Massachusetts, said they have more than $45,000 in USDA grants that are frozen. The delay has put them behind in production, leading to an additional $15,000 in losses. They are also unsure of the future of an additional $100,000 in grants that they’ve applied for. “I have to rethink my entire business plan,” Roell said. “I feel shell-shocked.”
Within the USDA’s purview, the funding freeze has targeted two main categories of funding: grant applications that link agricultural work to diversity, equity, and inclusion initiatives and those enacted under the Inflation Reduction Act, which earmarked more than $19.5 billion to be paid out over several years. Added to the uncertainty of the funding freeze, among the tens of thousands of federal employees who have lost their jobs in recent weeks were officials who manage various USDA programs.
Following the initial freeze, courts have repeatedly ordered the administration to grant access to all funds, but agencies have taken a piecemeal approach, releasing funding in “tranches.” Even as the Environmental Protection Agency and the Department of Interior have released significant chunks of funding, the USDA has moved slowly, citing the need to review programs with IRA funding. In some cases, though, it has terminated contracts altogether, including those with ties to the agency’s largest-ever investment in climate-smart agriculture.
In late February, the USDA announced that it was releasing $20 million to farmers who had already been awarded grants — the agency’s first tranche.
According to Mike Lavender, policy director with the National Sustainable Agriculture Coalition, that $20 million amounts to “less than one percent” of money owed. His team estimates that three IRA-funded programs have legally promised roughly $2.3 billion through 30,715 conservation contracts for ranchers, farmers, and foresters. Those contracts have been through the Environmental Quality Incentives Program, Conservation Stewardship Program, and Agricultural Conservation Easement Program. “In some respects, it’s a positive sign that some of it’s been released,” said Lavender. “But I think, more broadly, it’s so insignificant. For the vast majority, [this] does absolutely nothing.”
U.S. Agriculture Secretary Brooke Rollins announced the agency is unfreezing some funds, but it’s unclear how much is being released and how soon.
Saul Loeb / AFP via Getty Images
A week later, USDA secretary Brooke Rollins announced that the agency would be able to meet a March 21 deadline imposed by Congress to distribute an additional $10 billion in emergency relief payments.
Then, on Sunday, March 2, Rollins made an announcement that offered hope for some farmers, but very little specifics. In a press statement, the USDA stated that the agency’s review of IRA funds had been completed and funds associated with EQIP, CSP, and ACEP would be released, but it did not clarify how much would be unfrozen. The statement also announced a commitment to distribute an additional $20 billion in disaster assistance.
Lavender called Rollins’ statement a “borderline nothingburger” for its degree of “ambiguity.” It’s not clear, he continued, if Rollins is referring to the first tranche of funding or if the statement was announcing a second tranche — nor, if it’s the latter, how much is being released. “Uncertainty still seems to reign supreme. We need more clarity.”
The USDA did not respond to Grist’s request for clarification.
Farmers who identify as women, queer, or people of color are especially apprehensive about the status of their contracts. Roell, the beekeeper, said their applications for funding celebrated their operations’ diverse workforce development program. Now, Roell, who uses they/them pronouns, fears that their existing contracts and pending applications will be targeted for the same reason. (Federal agencies have been following an executive order taking aim at “Ending Radical And Wasteful Government DEI Programs.”)
“This feels like an outright assault on sustainable agriculture, on small businesses, queer people, BIPOC, and women farmers,” said Roell. “Because at this point, all of our projects are getting flagged as DEI. We don’t know if we’re allowed to make corrections to those submissions or if they’re just going to get outright denied due to the language in the projects being for women or for queer folks.”
The knock-on effects of this funding gridlock on America’s already fractured agricultural economy has Rebecca Wolf, senior food policy analyst at Food & Water Watch, deeply concerned. With the strain of an agricultural recession looming over regions like the Midwest, and the number of U.S. farms already in steady decline, she sees the freeze and ongoing mass layoffs of federal employees as “ultimately leading down the road to further consolidation.” Given that the administration is “intentionally dismantling the programs that help underpin our small and medium-sized farmers,” Wolf said this could lead to “the loss of those farms, and then the loss of land ownership.”
Other consequences might be more subtle, but no less significant. According to Omanjana Goswami, a soil scientist with the advocacy nonprofit Union of Concerned Scientists, the funding freeze, layoffs, and the Trump administration’s hostility toward climate action is altogether likely to position America’s agricultural sector to contribute even more than it does to carbon emissions.
Agriculture accounted for about 10.6 percent of U.S. carbon emissions in 2021. When farmers implement conservation practices on their farms, it can lead to improved air and water quality and increase soil’s ability to store carbon. Such tactics can not only reduce agricultural emissions, but are incentivized by many of the programs now under review. “When we look at the scale of this, it’s massive,” said Goswami. “If this funding is scaled back, or even completely removed, it means that the impact and contribution of agriculture on climate change is going to increase.”
The Trump administration’s attack on farmers comes at a time when the agriculture industry faces multiple existential crises. For one, times are tight for farmers. In 2023, the median household income from farming was negative $900. That means, at least half of all households that drew income from farming didn’t turn a profit.
Additionally, in 2023, natural disasters caused nearly $22 billion in agricultural losses. Rising temperatures are slowing plant growth, frequent floods and droughts are decimating harvests, and wildfires are burning through fields. With insurance paying for only a subset of these losses, farmers are increasingly paying out of pocket. Last year, extreme weather impacts, rising labor and production costs, imbalances in global supply and demand, and increased price volatility all resulted in what some economists designated the industry’s worst financial year in almost two decades.
Elliott Smith, whose Washington state-based business Kitchen Sync Strategies helps small farmers supply institutions like schools with fresh food, says this situation has totally changed how he looks at the federal government. As the freeze hampers key grants for the farmers and food businesses he works with across at least 10 different states, halting emerging contracts and stalling a slate of ongoing projects, Smith said the experience has made him now consider federal funding “unstable.”
All told, the freeze isn’t just threatening the future of Smith’s business, but also the future of farmers and the local food systems they work within nationwide. “The entire food ecosystem is stuck in place. The USDA feels like a troll that saw the sun. They are frozen. They can’t move,” he said. “The rest of us are in the fields and trenches, and we’re looking back at the government and saying, ‘Where the hell are you?’”
A photo series celebrating lineages of liberation through Afro-descendant land stewardship across South Texas, Western Cuba, and la Costa Chica de México. During seasons of great social and political upheaval, history has proven that community safety and survival rely on our connections to one another and the land. My paternal grandmother, born in Jasper County, […]
North Carolina churches join lawsuit against policy allowing ICE into places of worship
Iglesias de Carolina del Norte se unieron a una demanda junto a más de veinticuatro entidades religiosas, en contra de la política que permite al Servicio de Inmigración y Aduanas (ICE, en inglés) en “lugares sensibles”, incluyendo lugares de culto.
Rural North Carolina counties would suffer most from Medicaid cuts
A push by Congressional Republicans to slash federal funding for Medicaid could have “dire consequences” for the more than 1.2 million rural North Carolinians who depend on the program.
That was the key takeaway from a report released in January by the Center for Children and Families at the Georgetown University McCourt School of Public Policy. Rural communities, the researchers wrote, are likely to bear the brunt of the cuts being contemplated in Washington because they make up a disproportionately large share of the state’s Medicaid enrollment.
A little over 39 percent of all Medicaid beneficiaries in North Carolina live in rural counties, according to an NC Health News analysis of the latest enrollment data from the state Department of Health and Human Services. A county is considered rural if it has fewer than 250 residents for every square mile of land.
Suburban counties, which are more densely populated, account for nearly 29 percent of the state’s beneficiaries. Urban counties with large cities make up about 32 percent.
Republicans in the U.S. House of Representatives are weighing various options to reduce federal spending on Medicaid in an effort to offset the cost of President Donald Trump’s plan to extend trillions of dollars in expiring tax cuts. But experts say all of the proposals floated so far would most adversely affect the same rural communities that carried Trump to victory in North Carolina.
Trump was the overwhelming favorite among rural voters in the 2024 presidential election, defeating former Democratic Vice President Kamala Harris in 66 of the state’s 78 rural counties. However, NC Health News found that some of those Trump-supporting counties have more residents enrolled in Medicaid than residents who voted, underscoring the program’s importance to rural populations.
In rural Robeson County, for example, Trump was the top vote-getter among the 47,094 residents who cast ballots. Nearly 66,800 people in Robeson — or roughly 57 percent of the county’s population — are covered by Medicaid.
The election happened less than a year after North Carolina became the 40th state to expand access to Medicaid in December 2023. Under expansion, the maximum allowed household income for eligibility increased to 138 percent of the federal poverty level, or just under $36,000 annually for a family of three.
More than 600,000 newly eligible residents have joined the rolls since expansion took effect, swelling the state’s total enrollment to 3 million. NC DHHS has said the majority of people who gained coverage through expansion live in rural counties. Eight out of 10 of the new enrollees are adults with jobs, the statistics show.
“Medicaid is important in every state,” Leonardo Cuello, a research professor at Georgetown, told an audience of North Carolina-based health advocates during a recent webinar. “But man, is it really extra important in states with lots of rural areas.”
Children at risk
While Medicaid is most commonly associated with low-income adults, Erica Palmer Smith, executive director of the advocacy group NC Child, said the program is “vitally important” to children in the state.
“We have so many children who are dependent on the services provided through Medicaid for things as simple as their regular well checks,” she said in an interview with NC Health News. “But also when those children have a medical emergency or when they have a medical need, they don’t have another means for coverage than through our Medicaid program.”
That’s especially true for children in rural areas. Georgetown estimated that 237,800 children in rural North Carolina counties were covered by Medicaid in 2023, which translates to about 30 percent of all children living in rural areas based on population projections by the N.C. Department of Commerce.
“So many families across North Carolina are dependent on Medicaid for their children’s coverage, and so there is a lot of, I think, concern by a lot of those families around what could happen,” Smith said. “We don’t know what’s going to happen, but there is definitely a lot of concern because this is so important to those kids and their families.”
Medicaid begins benefiting many children before they’re even born.
Cuello said about 38 percent of North Carolina’s births are covered by Medicaid. The state, he added, pays less than a third of the $10,000 cost to deliver a baby from a mother enrolled in the program.
“With Medicaid, North Carolina can pay for more than three births with $10,000, so you’re getting three for the price of one,” he said. “Imagine if Medicaid goes away and you still have the same number of births to pay for.”
Hospitals in jeopardy
Cuts to Medicaid could also mean pregnant women in rural counties have fewer places to give birth.
Mark Holmes, director of the Cecil G. Sheps Center for Health Services Research at UNC Chapel Hill, said the program is a major source of funding for the state’s rural hospitals, many of which are struggling financially.
“Without Medicaid, many of these people on Medicaid would be uninsured,” Holmes said in an interview with NC Health News. “Medicaid decreases the uncompensated costs that hospitals are covering. We might call this ‘charity care’ in a more layperson kind of language, but the notion is that if you are sick and you go to the emergency room, they’re going to take care of you. And if you have Medicaid, then hospitals are getting money for it.”
Twelve rural hospitals in North Carolina have either shut down or stopped providing inpatient care since 2005, according to data from the Sheps Center. At least 10 other hospitals in rural parts of the state are at risk of going under.
If they do, residents will be forced to travel farther for essential services. That would exacerbate existing barriers to care for Medicaid beneficiaries in rural counties, who Holmes said “tend to be less able to transport to other locations.”
“They’re more likely to stay and get their care locally, whereas someone who lives in a rural area but has a job an hour away in an urban setting might get their health care there,” he said. “Someone who lives in a rural area who’s on Medicaid may be more likely to get their care locally, and rural hospitals fill that important role for those local populations.”
Cuello said that rural hospitals “rely on Medicaid payments to literally keep the lights on.”
“If you slash Medicaid funding for North Carolina, some of these hospitals that depend on Medicaid reimbursement are going to close, and that has health impacts for people in rural areas who have nowhere else to go,” he said, adding that hospital closures often have a ripple effect on local economies.
Previous research by Holmes has found that rural hospital closures are associated with a per capita income loss of between $703 and $1,300, along with an uptick in local unemployment rates.
“These hospitals are big employers and the economic engines of some of these rural counties,” Cuello said.
Broader concerns
Reduced federal funding for Medicaid could have other ramifications for rural areas.
Cuello noted that the program is the nation’s largest payer for substance use disorder treatment. It allows people in rural counties that have been ravaged by the opioid epidemic to access addiction and recovery services that would otherwise be unavailable to them.
The North Carolina Office of the Chief Medical Examiner reports that in the previous year, rates of opioid overdose fell by about 27 percent in 2024, the year after expansion went into effect.
Medicaid also pays for more than 60 percent of the state’s nursing home stays. That coverage is particularly important for rural populations, which skew older than those of urban and suburban counties.
“Medicare does not, repeat, does not pay for nursing homes,” Cuello said, referring to the similarly named program for older adults and people with disabilities. “It is actually Medicaid that pays for ongoing nursing home needs for seniors and similar placements for people with disabilities.”
Health care isn’t the only thing at stake. North Carolina receives about $14 billion a year from the federal government to run Medicaid, freeing up state dollars for other priorities like education.
Cuello said less than $9 billion of the state’s General Fund is earmarked for Medicaid, while the state pays more than $20 billion on K-12 schools. But that calculus could change if the feds decide to scale back spending on Medicaid.
“All of those federal dollars that are coming in for Medicaid are allowing the state to spend twice as much of its state dollars on education as it does on Medicaid,” he said. “If you take away the federal Medicaid dollars? Yes, that hurts health care, but also education and other state priorities — because how does the state sustain its high spend on education if it loses its biggest source of federal revenue?”
Speaking out
Amber Mosher grew up in a rural North Carolina town about 20 minutes from the nearest hospital.
Her parents, who worked in construction and retail, couldn’t afford health insurance. They relied on Medicaid to pay for Mosher’s health needs.
“It is how I got my vaccinations,” she said. “It’s how I was able to see a doctor when I was sick.”
Now the vice president of health policy at Washington-based communications firm GMMB, Mosher said it is important for Medicaid beneficiaries to share their own experiences with federal lawmakers.
“Sometimes folks can get lost in the sauce when you talk about data and statistics,” she said. “But when you pair that with stories about real people, real health care providers and real small town business owners, it really helps folks understand the real-life impacts of something like cutting federal Medicaid dollars.”
Mosher said GMMB is working with Georgetown to “help folks tell the story of North Carolina and how Medicaid supports your rural communities.” NC Child is also soliciting testimonials from families who have benefited from the program.
The organizations hope that members of the state’s delegation in Washington can be persuaded to remove Medicaid from the chopping block if enough of their constituents speak up.
“Everyone in North Carolina has friends, family, neighbors or coworkers who are being supported by Medicaid right now, whether they know it or not,” Cuello said, adding that people “might not stand for cuts to Medicaid if they understood what Medicaid is doing.”
Dive deeper
NC Health News analyzed data from multiple state agencies and organizations while reporting this story. Check out this spreadsheet for a county-level look at what we found.
