Durham officials warn Medicaid and SNAP funding changes could leave thousands uninsured and shutter local nutrition program

At a Durham County Board of Commissioners work session, county social services and public health officials warned that pending federal and state changes to Medicaid and Supplemental Nutrition Assistance Program (SNAP) funding could cause thousands of local residents to lose coverage and threaten the county—s longtime DINE nutrition-education program.

Maggie Clapp, director of Durham County Department of Social Services, told the board that if the state does not act to fix the hospital provider tax and related "trigger law," an estimated 17,000 Durham residents enrolled under Medicaid expansion could become uninsured. Clapp said the policy changes would also add administrative burdens, including frequent recertifications and new work requirements that could cause coverage lapses.

The potential loss of federal SNAP funding would also have large local effects, officials said. Clapp told commissioners that Durham currently provides SNAP benefits to 32,897 participants and that some state scenarios would require North Carolina to assume roughly $420,000,000 in new annual benefit costs; the state administrative share was described as an additional roughly $16,000,000. Clapp said those state-level shortfalls would in turn raise county administrative costs. "If the 25% next year is in effect, it would if we have the same numbers, we would be losing or having to come up with on our own 2,600,000.0," she said about Durham—s estimated additional county share.

Why it matters: Medicaid and SNAP together underpin access to health care and food for low-income households. County officials said cuts or new requirements could reduce consumer spending in local stores, increase uncompensated care at hospitals and strain county operations that handle eligibility and benefit administration.

What officials said: Clapp outlined the mechanics that could trigger the changes: a reduction in the provider tax for expansion states, coupled with new verification and work requirements that would narrow who remains covered. "I believe this is a way, in all honesty, to get people off of Medicaid because it's a lot of times during the recertification process, if you don't have the right forms, of course, that can delay it and then you get, put off Medicaid and you have to reapply," she said. Clapp added states could seek delays, but still urged local preparedness.

Public health officials cautioned the board that a separate but related cut will hit nutrition education. Dr. Rod Jenkins, Durham County public health director, said House Bill 1 eliminates SNAP-Ed funding effective Oct. 1, 2025, which would remove about $1,000,000 in fiscal 2026 funding for the county—s DINE (Durham Innovative Nutrition Education) program. Jenkins said the loss "directly impacts 13 positions" — "12 registered dietitians and 1 processing assistant" — and that unless alternative funding is secured the program "in its current form [will] discontinue after 09/30/2025." He told commissioners the county had identified roughly $200,000 in existing public health funds and had submitted requests for additional local support while pursuing outside grants and philanthropic partners.

County manager Marisha Hager told commissioners staff are reviewing short- and long-term options. "My strategy will be to make sure that we are cognizant that the programming that's been helping the community for years stay intact as best as we can," she said, adding that departments are doing budget deep dives and that the manager—s office will return to the board with tactical short-term and longer-range proposals.

Board response and next steps: Commissioners pressed staff for more detail. Commissioner Jacobs asked for demographic breakdowns of expansion enrollees and for best/worst-case scenarios to support advocacy to the General Assembly. "I think it's gonna be catastrophic for every single county in North Carolina," Jacobs said of a full rollback of expansion coverage. Commissioners also urged proactive local outreach, cross-sector coordination and immediate engagement with the county—s federal and state delegation.

Several commissioners and staff suggested short-term bridge funding and faster reporting to the board while the county pursues state, federal or philanthropic backstops. Public health leaders requested county consideration of partial funding scenarios; Commissioner Phillips publicly supported a county funding plan that would preserve a larger share of DINE services pending outside support.

What remains uncertain: Officials said some details depend on North Carolina—s legislative actions and federal guidance. Clapp noted states can request delays for implementation of work requirements, and she said the complex mix of funding scenarios means county costs could vary widely; where the legislature acts will determine whether the added requirements apply. Jenkins and public health staff said they will continue to seek grants and philanthropic partners but warned that foundation and grant timelines are slower than the Sept. 30 funding cliff for DINE positions.

Follow up: Staff agreed to return with more specifics, including demographic breakdowns of the local Medicaid expansion population, a run-rate showing how long newly-available county-returned funds will sustain planned expansions, and a short-term funding proposal to help preserve DINE positions while the county seeks outside grants. Commissioners directed staff to accelerate outreach and reporting to the board as the situation develops.

Ending: Until state or federal policy action changes, Durham officials said they will prioritize outreach, eligibility-assistance expansion and short-term financial options to reduce immediate harm to residents who rely on Medicaid, SNAP and county nutrition programs.