A possible Medicaid cut on the horizon, sparking concern across our region, from lawmakers scrambling to soften the blow to local clinics finding innovative ways to stretch every dollar.

"Carolina Impact's" Chris Clark has the story.

(rapid whooshing) - [Chris] With $880 billion in proposed Medicaid cuts, more than 2 million North Carolinians face an uncertain future.

The repercussions could stretch from city hospitals to rural clinics, altering care and access.

- It's a huge amount of money that will cause us to have to re...

I call it reform our whole Medicaid system.

- It's frustration and a little bit of anger set up there, particularly here in North Carolina.

We spent a lot of time getting to the point where we were going to get the funds for Medicaid that are gonna trickle down to us.

- [Chris] Last year, $6.2 billion of North Carolina's $30 billion state budget was allocated to Medicaid, with a significant portion going towards Medicaid For All that began in December of 2023.

It provides coverage for residents age 19 and older earning $20,000 or less annually.

And today, over 650,000 people are enrolled.

Healthcare leaders call it a transformative step for access in the state.

But now, it's at risk of being one of the first casualties in the face of proposed cuts.

- Anybody that's been in North Carolina for any amount of time knows how long it took us to get here.

And it's predicated on the fact that the federal government is going to continue to fund Medicaid expansion.

So we've got that trigger in place that if the Medicaid expansion funding that we're getting from the federal government drops below 90%, Medicaid expansion goes away.

And once that genie's outta the bottle, it's hard to get it back in.

- [Chris] It will also be more expensive.

Under Medicaid For All, people get preventative care.

They don't have to wait to get checked when they're sick, which often leads to more expensive visits to the ER.

- The emergency room, for all intents and purposes, will effectively be their primary care physician.

- [Chris] On average, ER costs are often five to 10 times higher than a primary care visit.

- It's not just compassion, but it makes good business sense.

Last year they did a study on our impact as a clinic.

And just from this one clinic, we represented a savings of $8 million back to the closest hospital.

And our budget's not even close to $8 million.

- [Chris] Cuts to Medicaid threaten not just the program itself, but also the Affordable Care Act, which relies on Medicaid funding.

For cancer survivor, Jennifer Snowhite, this is a matter of life or death.

- I noticed a lump in my breast a couple of years ago.

It was in the middle of the pandemic.

But it was tiny, so I was pretty sure it was a cyst and ignored it for two months.

And then the next month, I felt something the size of a golf ball.

- [Chris] Thanks to her health coverage under the ACA, Jennifer was able to act quickly.

- Within days, I had gotten the information that I needed a mastectomy (fingers snapping) like that.

And if it hadn't all gone so smoothly and so quickly, I just...

I can't even imagine what would've happened.

- [Chris] Healthcare access became even more critical when her husband faced a life-threatening cancerous tumor of his own.

Snowhite credits the Navigator program with securing the right coverage for her husband and saving his life, something she fears could become unattainable for others if Medicaid cuts happen.

- Without coverage, we'd both be dead.

Our kid would be an orphan.

You know, we wouldn't be working, producing, living happy lives.

- [Chris] With every option on the table, lawmakers have batted around ideas.

The first is having a work requirement for expanded Medicaid.

- So if you were working poor, you would be eligible for that expanded population.

- [Chris] Some people may lose eligibility if they can't meet the work requirement due to health issues or caregiving responsibilities.

Supporters believe this is gonna encourage people to find jobs that may offer employer-sponsored health insurance, reducing their reliance on Medicaid.

Telehealth, where patients have appointments with doctors online or over the phone, is an area that seems to be incredibly cost-effective at both reducing healthcare costs and helping patients.

- What we're finding is that we can resolve the tactical piece of healthcare in five minutes over the phone or, you know, three minutes via text.

So the efficiency is much greater.

And then the economic impact on the community's greater.

Because now, the person doesn't have to take a whole day off work to come and sit and wait.

- [Chris] Others are looking at eliminating redundancy by combining services from hospital group to hospital group.

Allowing different hospitals to share patient records will cut costs, along with rewarding hospitals for performance measures.

- Do you know which is the best performing hospital in North Carolina?

No, nobody knows.

Now, do you think you know?

Well, is that because of the marketing campaigns?

Is it because of the basketball team?

What do you think measures quality in our healthcare system in North Carolina?

We don't measure quality.

- [Chris] North Carolina faces some tough decisions, including the possible elimination of unique programs, like the Health Opportunities Pilot.

This initiative addresses critical needs beyond medical care, such as housing assistance, food access, and transportation to medical appointments.

Another option on the table is freezing reimbursement rates paid to healthcare providers, a move that could strain services, but help control costs.

- Will they like that?

Not likely.

But is it a matter of cutting back a program or taking people off the Medicaid rolls, versus everybody's gonna have a freeze in their rates?

- [Chris] The state did buy itself some time to navigate these challenges.

- We've actually been building up some reserves for Medicaid, knowing that we may have to phase down some of these reductions, so that it's not just...

I call it cold turkey, where all of a sudden you're covered one day, and the next day, you're not.

It might be January before we eliminate a certain segment of those services.

- [Chris] The true anxiety stems not just from the cuts of the programs on the chopping block.

It's the unsettling uncertainty of how these changes will disrupt and reshape lives.

- One in five seniors who rely on Medicaid for their senior living facilities, where are they gonna go?

And it's gonna be up into 300,000 children are gonna be impacted.

If you wanna see what people really care about, look at how they spend their money.

'Cause that's the clearest way you'll see where their priorities are.

- [Chris] As lawmakers weigh the consequences, the uncertainty about who will be affected and how remains the most unsettling aspect for families.

For "Carolina Impact," I'm Chris Clark.