North Carolina’s Rural Health Systems Are in Crisis

Expanding Medicaid would improve child health outcomes and support COVID-19 recovery efforts

By: Katie Spears Warner | July 2020

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Across North Carolina, rural health systems are in grave danger. In states like ours that have chosen not to expand Medicaid, rural hospitals and health systems have experienced significant financial stress and even closures over the last decade. A new issue brief from NC Child explores how policy solutions like expanding Medicaid could protect jobs and health in rural North Carolina.  

Since 2014, North Carolina has lost six rural hospitals, limiting health care access and impacting rural communities, families, and economies. Now, of North Carolina’s 100 counties, 20 rural counties don’t have a hospital and 35 are without any ICU beds

“If my provider or hospital closes, the next closest hospital is 45 minutes away. Pediatric services are limited for the area I live in, especially when it comes to mental health and dentistry.” – Erica Banks, Pasquotank County


Although rural communities seemed to initially be isolated from COVID-19, the virus is now spreading rapidly in many rural areas. Adding to years of financial strain, more vulnerable rural hospitals, small family practices, and pediatricians are struggling to stay in business as they grapple with the devastating impacts of COVID-19. Roxie Wells, of Cape Fear Valley Health recently reported to NC Health News that rural hospitals are losing about $145 million each month due to the coronavirus pandemic.

Medicaid Plays a Critical Role for Rural Families

For North Carolina families who live in small towns and rural areas, Medicaid provides vital coverage. More than half of children in rural communities receive their health coverage from Medicaid andNC Health Choice. By expanding Medicaid to cover more low-income adults in North Carolina, we can increase the chances that rural hospitals can stay open, protect jobs, and ensure access to health care for thousands of families. In states that have already taken this action, more patients are able to pay for vital health care services. 

  Medicaid is a lifeline for kids in rural North Carolina. Medicaid coverage brings opportunities that many kids just would not otherwise have, from being able to catch developmental delays early, to getting the eyeglasses they need to do well in school. It also means that there are health care providers like pediatricians here to provide care for kids – because there is coverage to pay for care.”
– Dr. David Tayloe, Goldsboro Pediatrics 

North Carolina lags behind other states that have taken action on Medicaid since the Affordable Care Act was enacted ten years ago. On June 30th, voters in Oklahoma approved a ballot measure to expand access to Medicaid to more uninsured adults, making it the 37th state to do so. Not one state has reversed this decision since expansion became an option for states in 2014.  

Rural Response and Recommendations

Rural organizations – nonprofits, funders, tribal and local governments, schools – are taking action to provide immediate and long-term relief for people who lack access to health care. But they need our help in responding to this crisis and improving health outcomes. We’ve asked rural leaders for their expertise and ideas on what will help their efforts the most. These recommendations are part of a new issue brief we’re releasing this week. 

  • The NC General Assembly should expand the state’s Medicaid program.
  • Congress should increase the federal share of Medicaid funds it provides to states during the pandemic.
  • NC’s leaders should make pandemic Medicaid telehealth policies permanent.

These recommendations have been proven to build up critical health infrastructure and resources to adequately address the rural health crisis already in progress, and are even more important as a response to the pandemic. These opportunities are well-researched and aimed at preventing providers and hospitals from shutting their doors to patients, especially at a time when so many need critical access to care. 

We know many of you are directly grappling with the rural health systems crisis in NC. Please be in touch and let us know how your community has been directly impacted in recent months, to inform our response and lift up ways we can support your efforts to ensure all children have access to health care.