Rural Robeson County hospital says Medicaid cuts are ‘deeply concerning’

The only hospital in one of North Carolina’s poorest counties faces a tough challenge after the passage of the Trump administration’s “One Big, Beautiful Bill” Act.

With 58% of Robeson County residents enrolled in Medicaid — and over 15% without any health insurance — UNC Health Southeastern and its patients will be hit hard by federal cuts.

Robeson County has one of the highest rates of Medicaid enrollment in North Carolina, with more than 20% of enrollees enrolled through the state’s recent Medicaid expansion.

“As a health care provider serving one of North Carolina’s poorest and most rural regions, UNC Health Southeastern is deeply concerned about the potential impact of the recently passed ‘One Big Beautiful Bill’ on Medicaid recipients and coverage in our area,” UNC Health President and CEO Chris Ellington said in a statement to The News & Observer.

Brianna Goodwin, director of the Robeson County Church and Community Center, said her organization is “brac[ing] for impact” from the Medicaid cuts in the megabill.

“Without any cuts of any kind, we are already at a great disadvantage,” Goodwin said.

More than a quarter of Robeson County’s roughly 105,000 residents live in poverty, with households having a median income of $40,318. Nearly half the people in the county, which voted over 60% for Trump in 2024, are Native American, primarily of the Lumbee and Tuscarora tribes, followed by almost equal percentages of white, Black and Hispanic residents.

“Our region has long relied on Medicaid to ensure access to care, and any significant reductions in coverage could be devastating for families who already face barriers to health and economic stability,” Ellington said.

Some health care providers in Robeson County do not accept Medicaid, Goodwin said, and cuts to the joint federal and state insurance program will only worsen an already real disparity.

She said she frequently sees residents come to the community center with hypertension and diabetes.

“The South is is known for excessive use of frying food,” she said. “A lot of just our lifestyle [is] more sedentary than when people live in larger cities that are walkable. There’s just so much more recreation. But when you live in rural areas, it’s not feasible to walk from place to place.”

Robeson County has an average life expectancy of 67.3, over nine years lower than the state’s 74.9 year average.

How hospitals may suffer under Medicaid cuts

Medicaid reimburses hospitals for services like private insurance companies do. According to the Emergency Medical Treatment and Labor Act, emergency medical providers must treat patients despite their insurance status. But when treatment is provided without reimbursement, hospitals suffer.

For hospitals like Southeastern that serve a high number of Medicaid patients and already operate at a loss, reduced funding could put a significant dent in revenue.

“Those hospitals in [rural] counties operate on a very small margin, and this is going to hurt,” said Josh Dobson, N.C. Healthcare Association president and CEO. “It’s going to cut into that margin even more, and there’s going to be challenges. No question about it.”

Ellington said Southeastern will have to make up costs from the reduction of Medicaid coverage. Despite the hospital operating at a loss for years, it is a part of the UNC Health system, which owns 16 hospitals statewide and made a profit of over $330 million in fiscal year 2023.

“As part of the state’s leading academic health system, we have access to deep expertise in areas such as reimbursement strategy, financial modeling, and operational planning, resources that would not otherwise be available locally,” Ellington said.

Goodwin said Robeson County Church and Community Center, which is privately funded by the Kate B. Reynolds Charitable Trust, will soon begin collaborating with Southeastern to provide more medical clinics and offer more care through on-site and mobile services.

Despite the troubles these cuts may bring, Ellington said UNC Southeastern does not anticipate closing. He said since the provisions in the bill will be implemented over the course of 10 years, they should have time to prepare.

How Medicaid will affect North Carolina

More than 3 million North Carolinians are on Medicaid, with more than 670,000 of them enrolled after North Carolina expanded it in 2023. Now, many of those who enrolled after expansion are at risk of losing coverage.

According to North Carolina law, if the federal funding for Medicaid expansion in North Carolina drops below 90% and the state can’t make up the cost, health coverage for those who enrolled through Medicaid expansion will be discontinued.

The “One Big, Beautiful Bill” Act cuts the budget for Medicaid in North Carolina by about $50 billion according to the North Carolina Department of Health and Human Services. The bill does allocate $50 billion to rural hospitals nationwide through a fund called the Rural Health Transformation Fund. But Jay Ludlam, deputy secretary for NC Medicaid, says that’s not enough to make up for the loss.

In a presentation to media in early July, Ludlam said the fund is anticipated to only make up for a third of the $3 billion cuts to rural hospitals in North Carolina.

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