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New Medicaid provision could require referrals to federal immigration authorities

The Legislative Building in Raleigh.
JMTURNER
/
Wikimedia Commons
The Legislative Building in Raleigh.

A Medicaid funding bill moving quickly through the North Carolina General Assembly with broad bipartisan support includes a provision raising concerns among advocates for immigrants.

North Carolina lawmakers voted almost unanimously in both chambers Wednesday to adopt a revised Medicaid proposal. The bill includes about $319 million to fund the state’s Medicaid program, which assists 2.4 million North Carolinians.

The revised proposal includes a provision requiring the state Department of Health and Human Services to refer some Medicaid applicants to the U.S. Department of Homeland Security if their citizenship or immigration status cannot be verified. The Medicaid application process is handled by county social services agencies, which would identify applicants for referral during eligibility checks.

Advocates say that could discourage immigrant families from seeking Medicaid, particularly in mixed-status households where some members are U.S. citizens or legal residents and others are not.

“This isn’t about eligibility; it’s about terrorizing parents who just want to take their kids to a doctor," Siembra NC's co-director Kelly Morales said. "By forcing our county workers to act as federal informants, the state is making every child in our community less safe."

Another provision would limit Medicaid coverage for non-citizens, including those with legal status such as visa holders and green card holders, to the minimum of what is required under federal law.

Doug Sea with the Charlotte Center for Legal Advocacy, which helps low-income residents navigate health care and other public benefits, says the impact could extend beyond undocumented immigrants.

“Legal immigrants who came as refugees and asylees, they are all under severe attack at both the federal level and at the state level,” Sea said.

The bill still needs final approval from both chambers and is expected to reach Gov. Josh Stein's desk next week.

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Julian Berger is a Race & Equity Reporter at WFAE, Charlotte’s NPR affiliate. His reporting focuses on Charlotte's Latino community and immigration policy. He is an award-winning journalist who received the 2025 RTDNAC Award for an economic story examining how fears of immigration enforcement affected Latino-owned businesses in Charlotte.