Reconciliation Bill Makes It Harder to Get Mental Health Care
This letter was sent to the editors of regional publications, reprinted here:
Dear Editor,
As Congress considers cuts to Medicaid funding, North Carolinians must understand what's at stake for mental health care across our state, particularly in Eastern North Carolina, where access to care is already limited.
The numbers tell a stark story. More than 270,000 North Carolinians could lose their Medicaid coverage(1) under proposed federal budget changes. This isn't just about insurance statistics--it's about real families in our communities who depend on this coverage for essential mental health and substance use treatment.
In North Carolina, 26% of residents rely on Medicaid, including almost 58,000 veterans and 43% of children across the state(1), more than the national average. Among those enrolled in Medicaid today, nearly one in four people has a mental health condition or addiction(1). These aren't abstract numbers--they represent our neighbors, coworkers, and family members who are working to build stable, healthy lives.
Medicaid serves as the backbone of mental health care nationwide, covering 25% of all mental health services and 40% of substance use treatment(1). In North Carolina, almost 22,000 people received opioid use disorder treatment through Medicaid in 2022(1). This investment is working: we've seen a 29% decrease in overdose deaths in 2024(1). Rolling back this progress would be devastating.
The proposed changes include work requirements, cost-sharing mandates, and burdensome six-month eligibility reviews. While these may sound reasonable on paper, research shows they create administrative barriers that prevent people from accessing the very care that helps them stay healthy and productive. When someone loses Medicaid coverage, even temporarily, their treatment gets interrupted, often leading to crisis situations that cost far more than prevention.
Eastern North Carolina faces particular challenges, with ten rural hospitals at risk of closing statewide(1). When Medicaid funding decreases, these hospitals lose critical revenue, threatening emergency services and specialized care for entire regions. The average cost of an uninsured emergency room visit is $1,626, far more expensive than maintaining consistent coverage and care(1).
Additionally, Medicaid funds mobile crisis response for mental health emergencies in our communities and mental health support in our schools that help our children thrive. These proposed changes threaten the life-saving work of these programs and directly impact our children and our most vulnerable neighbors.
Our communities are still grappling with the mental health impacts of recent years. Now is not the time to reduce access to care. Protecting Medicaid means protecting the mental health infrastructure that keeps families together and communities strong.
We urge Senators Tillis and Budd to stand with North Carolina families and oppose cuts to Medicaid funding. Protecting Medicaid is protecting mental health. Our state's mental health depends on it. Lives depend on it.
Sincerely,
Timothy Grant Livengood, MSL, MBA
Chairman, Board of Directors
On behalf of: Mental Health America of Eastern Carolina
Greenville, NC & Raleigh, NC | mhaec.org
References: 1. Inseparable. (2025). The reconciliation bill makes it harder to get mental health care: The impact in North Carolina [Fact sheet]. https://www.inseparable.us/
