North Carolina lawmakers approved final passage of $319 million in Medicaid funding to keep the state program afloat after months of uncertainty. It now heads to Democratic Gov. Josh Stein’s desk for his signature.
The funding bill passed nearly unanimously in the House and Senate, with three Democratic lawmakers voting against it in each chamber, citing misgivings over provisions in the bill they said would deny Medicaid coverage to 27,000 pregnant women and their children based on immigration status.
A Stein spokesperson said the governor was reviewing the bill Tuesday evening.
Sen. Natalie Murdock (D-Durham) praised the bill for allowing millions to keep their healthcare and giving medical providers the funding needed to keep their doors open.
But she condemned lawmakers for including the provision stripping immigrant patients of coverage, which goes beyond the restrictions on healthcare for immigrants set by last year’s One Big Beautiful Bill Act. Lawmakers are “making a choice,” Murdock stressed.
“We’re talking about a lot of pregnant women and their children that will no longer have coverage,” she said. “And we can’t just leave it up to hopefully getting clarification on how it’s interpreted. I’m hoping for this body to do everything they can to formally make this right.”
NC lawmakers will fill Medicaid funding gap, but larger state budget issues remain unresolved
The provision stipulates that “Medicaid coverage for individuals who are not citizens of the United States shall be limited to coverage that is federally required for the State’s participation in the Medicaid program.” It eliminates coverage guarantees for pregnant undocumented immigrants, as well as some groups of immigrants with legal status, including refugees.
Senate Republicans said they are unsure whether the language of the bill would remove coverage for those 27,000 individuals, adding that they are waiting on further guidance from federal partners before considering potential remedies to the issue.
Other provisions of the bill require the North Carolina Department of Health and Human Services to collect information on patients’ immigration status and report suspected undocumented immigrants to Homeland Security. And advocacy groups have also raised concerns over increased inpatient copays and work requirement vetting periods, both of which will be set at the maximum allowed by the federal government.
Sen. Benton Sawrey (R-Johnston) said Republican lawmakers did not intend the Medicaid bill to deprive immigrant women of coverage for pregnancy care on Tuesday, April 28, 2026. (Photo: Brandon Kingdollar/NC Newsline)House Speaker Destin Hall (R-Caldwell) celebrated passage of the bill following the votes, telling reporters that North Carolina must get control of Medicaid spending before it prevents the legislature from funding priorities such as public safety and teacher pay raises.
“It’s grown out of control,” Hall said. “Our goal on my side of the aisle is to have a program in place that meets the needs of those folks who truly need it. And the real measure of success is how many folks who get on it, who are able to work, are able to get off of it.”
Sen. Benton Sawrey (R-Johnston), who presented the bill to his chamber, said his caucus is consulting with attorneys, federal bill drafters, and the U.S. Centers for Medicare and Medicaid Services to determine whether changes are necessary to avoid disrupting care for immigrant patients. “We truthfully did not think it was an issue,” he said.
“No change, intention, was contemplated at all under any circumstances to take these people off of Medicaid,” Sawrey said. “And there is a legitimate question thanks to CMS guidance as to whether the current draft that we have would have an impact at all.”
This assurance was not enough for some Democrats, however.
Sen. Michael Garrett (D-Guilford), the sole Senate vote against the bill last week, said he could not support a measure of which, he said, “the cruelty is the point.”
Sen. Michael Garrett (D-Guilford), one of three senators to vote against the bill, urged lawmakers not to “use pregnant women as bargaining chips” in a 10-minute floor speech on Tuesday, April 28, 2026. (Photo: Christine Zhu/NC Newsline)Speaking for more than 10 minutes, Garrett called on his colleagues to oppose the bill. “You do not have to accept that your legislature uses pregnant women as bargaining chips.”
“We are about to betray mothers and children,” Garrett said. “She will not know until she calls her clinic and a stranger tells her on the other end of the line that her appointment scheduled a few weeks ago is no longer covered.”
Garrett was joined in opposing the bill Tuesday by his newest colleague, Sen. Jonah Garson (D-Orange), as well as Sen. DeAndrea Salvador (D-Mecklenburg). In the House, the bill was opposed by Rep. Pricey Harrison (D-Guilford), Rep. Marcia Morey (D-Durham), and Rep. Ed Goodwin (R-Chowan).
Sen. Jim Burgin (R-Harnett), who chairs the Senate Health and Human Services budget committee, reiterated that “never was it in our intention to impact these folks.”
“There was never any intended plot to do what you spoke of. I mean, that just wasn’t even in it. I think you all know me and my heart for children,” Burgin said. “I give you my word, we’ll continue to work on this bill. We have time. But we need to go ahead and pass this.”
NC Newsline reporters Lynn Bonner and Christine Zhu contributed to this story.
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