North Carolina implements Medicaid work requirements; over 250,000 beneficiaries may lose coverage

North Carolina has begun enforcing Medicaid work requirements authorized under the 2025 reconciliation law, with state officials estimating more than 250,000 beneficiaries could lose coverage for non-compliance. This is the largest-scale implementation to date of the federal policy mandating work, volunteer, or training hours for certain Medicaid enrollees. Clinics in North Carolina should prepare for an influx of patients losing Medicaid coverage and needing to transition to other payers or become self-pay. Front desks must verify eligibility with increased frequency, and billing teams should model the revenue impact of a shrinking Medicaid population in their payer mix.