Medicaid Managed Care

Rising Costs, Shrinking Care: The Reality of Medicaid Managed Care

North Carolina’s shift to Medicaid Managed Care was supposed to save money and simplify care – but instead, it’s creating more costs, more bureaucracy, and more barriers for patients and providers across the state.

THE FACTS

North Carolina saved nearly $830 million by moving to Medicaid Managed Care — but as of Oct. 2025, those savings have now been overtaken by $836.2 million in non-benefit spending (Joint Legislative Oversight Committee on Medicaid).

SAVINGS LOST, RISING COSTS

North Carolina’s move to Medicaid Managed Care (MMC) was meant to save money and streamline services — and at first, it did. But those early savings have now been wiped out by growing non-benefit spending, including:

General administration: Overhead like billing, IT systems, compliance, and marketing – costs that don’t fund actual medical care.

Care management: Administrative costs, including expenses for case-management platforms and the salaries of care coordinators.

Risk and plan margins: Payments set aside for insurers’ financial risk, reserves, and profit margins rather than direct care.

In short: what the state saved on one side of the ledger has been erased on the other. Whether the system is being mismanaged or simply unmanageable, MMC isn’t delivering the efficiency or accountability North Carolinians were promised — and it’s not lowering costs.

Why this Matters to You

When a system built to manage care becomes more expensive than the care itself, cost-cutting becomes inevitable. And if nothing changes, patients and providers could end up carrying the greatest burden.

FOR PATIENTS

Less access: Networks could shrink, making it harder to find doctors or specialists — especially in rural communities.

More hurdles: Plans may rely more on prior authorization, creating potential delays and denials for tests, medications, and procedures.

FOR PROVIDERS

Lower reimbursement: Hospitals and practices could face further financial strain, leading to service cuts or dropping certain Medicaid plans.

More paperwork: Administrative requirements could increase, pulling even more time away from patient care.

TIME FOR ACTION

Medicaid Managed Care may have been created with good intentions, but it is clearly not delivering on its promise to North Carolina.

It’s time for state lawmakers to step in — to demand transparency, protect North Carolinians from further budget cuts, and ensure Medicaid dollars are spent where they matter most: on patient care, not bureaucracy or profit margins.

The future of healthcare in North Carolina depends on course-correcting now, before more damage is done.

Let’s Heal the System, Together.

Policymakers, community leaders, and engaged citizens: Join us in the fight to heal North Carolina’s healthcare system.

Stop financial harm to hospitals and providers. Hold insurance companies accountable. Protect care for every community.