Cumberland County public health officials say their concerns have grown that some low-income residents could lose Medicaid coverage and food assistance after the U.S. House passed a federal megabill last week.
The “One Big Beautiful Bill Act,” which passed on May 22 with a vote of 215-214, includes an almost $800 billion decrease in federal spending on Medicaid and a drop of $285.7 billion for SNAP, the Supplemental Nutrition Assistance Program also known as food stamps, over the next decade.
The bill now goes before the Senate, where it is likely to pass with some changes, according to Politico. Once passed, it will head back to the House for approval before being sent to President Donald Trump for a signature.
“We’re a long way from any official legislation, but what we have so far is scary,” Brenda Jackson, director of Cumberland County Department of Social Services, said in the department’s board meeting on Wednesday.
The legislation includes work requirements for SNAP and Medicaid beneficiaries. Currently, SNAP recipients with children under 18 aren’t required to work. The bill says those with children under 7 and who don’t qualify for an exemption must be employed. It also raises the age for general work requirements for adults without children.
Under the bill, by the end of 2026, Medicaid recipients would be required to complete at least 80 hours of work, education, community service or a combination of the three per month. They could also earn an income equal to at least 80 hours of work at the federal minimum wage per month to meet the requirement.
County social services employees would be required to verify beneficiaries are meeting the work requirements each renewal period, which happens every six to 12 months in North Carolina depending on the Medicaid plan.
Sixty-four percent of adults under 65 who are enrolled in Medicaid and don’t receive other benefits like Social Security or Medicare already work full or part time, according to KFF, an independent health research organization. In total, 92% are either working, in school or would meet one of the work requirement exemptions in the House bill.
Similar work requirements implemented for a year in Arkansas resulted in an increase in the uninsured population and no change in the number of people working, according to a 2019 study published in The New England Journal of Medicine.
“A lot of these items in this legislation are designed to make it more difficult for people to receive services,” Jackson said.
Vivian Tookes, economic services assistant director for the Cumberland County Department of Social Services, said she was especially concerned about how the changes would affect homeless residents. She said she regularly speaks to unhoused people, including a mother and daughter who live near a local grocery store and rely on federal programs.
“Individuals get maybe $200-plus dollars a month for food and nutrition, and to see some of them not getting that money, and how it could delay them as far as their needs, really grabs me,” Tookes said at the board meeting.
Cumberland County is home to 374 homeless residents, according to the 2024 Point-in-Time Count, the annual, 24-hour census of homeless residents. There are likely more than the census indicates as homelessness service organizations like the Fayetteville-Cumberland County Continuum of Care report serving hundreds more homeless residents.
Local social service officials said they were also worried because the bill would shift much of the cost of SNAP and Medicaid to the states. Currently, the federal government pays for the majority of programs. In North Carolina, each county is responsible for 50% of administrative costs, and the state pays for a portion of Medicaid health care costs.
If passed as is, the House bill would increase the county’s SNAP administrative costs to 75% immediately upon passage, and require states to match at least 5% of the cost of SNAP starting in October 2027.
The bill also carries impacts for states providing Medicaid coverage to non-citizens. A 10% decrease in the federal Medicaid payment rate, from 90% to 80%, for states with Medicaid expansion would also start in October 2027 if that state has provided health care “to or on behalf of an alien who is not a qualified alien or otherwise lawfully residing in the United States.” Tookes said this provision could trigger what she called the “kill clause” in North Carolina’s Medicaid expansion law, which passed in 2023. The clause could immediately halt the state’s coverage of the expanded population immediately if the federal match rate falls below 90%.
In Cumberland County, 27,857 residents are covered by Medicaid expansion, according to data from the North Carolina Department of Health and Human Services. Cumberland County has the fourth highest number of residents covered by any Medicaid plan, with 47% of residents under 65 on some type of plan.
“It’s very, very alarming from the service side and how it will impact our citizens,” Jackson said. “It’s also very alarming about how it may impact our budget and our ability to be able to administer these programs.”
The federal-to-state cost shift comes as North Carolina faces decreasing state revenues. The state will lose 2.4% of its revenue between fiscal years 2025-2026 and 2026-2027, according to a February prediction by the Office of State Budget and Management.
With less revenue to go around and funds still needed for Hurricane Helene recovery, it’s almost impossible for the state to fund SNAP and Medicaid at their current level, Alexandra Sirota, executive director of the NC Budget & Tax Center, previously told CityView.
“There’s no way the state can take on any cost shift from the federal government at this point, even if those cost shifts are not as extreme as we’re hearing about,” Sirota said in March. “Any cost shift is not sustainable if we want to continue to deliver the services that are already being delivered to school children, to seniors and the community, to businesses seeking assistance. None of that will be possible.”
In anticipation of increased costs, Cumberland County Manager Clarence Grier didn’t include many new spending initiatives for the social services department in his proposed budget, Jackson said. The only new spending lines the department received were for two IT positions.
Jackson and Tookes emphasized that the House bill has yet to become law, and Jackson said there are signs that the Senate will lessen some of the cuts. State and national organizations representing Cumberland County are lobbying U.S. senators, including North Carolina’s Thom Tillis and Tedd Budd, to lessen proposed cuts.
“At this point, a lot of lobbying work needs to happen,” Jackson said. “And those balls have started to already move.”
CityView Reporter Morgan Casey is a corps member with Report for America, a national service program that places journalists into local newsrooms. Morgan’s reporting focuses on health care issues in and around Cumberland County and can be supported through the News Foundation of Greater Fayetteville.