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County sees Medicaid caseload stability after expansion; officials flag SNAP funding shift as risk
Summary
Orange County social services staff reported a steady overall caseload after Medicaid expansion, modest increases in some services and warned that recent federal proposals to shift SNAP costs to states could impose large new costs on North Carolina and counties.
County social services staff reviewed caseload and contract changes in the proposed FY2025–26 budget and warned that recent federal legislative proposals could materially affect county service costs.
Staff said Medicaid caseloads have stayed relatively steady since expansion. The presentation showed about 4,800 additional people receiving Medicaid because of expansion and a total caseload across programs averaging between roughly 20,000 and 21,000 individuals. Staff said the apparent flat line partly reflects concurrent “unwinding” of pandemic-era enrollment rules, which led to some people losing coverage while others gained it through expansion.
Social services staff also described program-level changes in the recommended budget: an increase of about $100,000 for in-home aid contracts tied to a living-wage adjustment and demand (estimated to buy roughly 60 hours per week of in-home aid), recognition of Medicaid and food-and-nutrition revenue increases that track costs, and elimination of a vacant position after the county lost a grant (NC Integrated Care for Kids). Staff said three large DSS contracts (IFC, OCIM and Solstice) had no change in funding.
During the briefing, DSS staff flagged a federal bill under consideration that, if enacted as described to the board, would shift an estimated portion of SNAP (food and nutrition) benefit and administrative costs to states. DSS staff estimated North Carolina could be responsible for roughly 20% of the program’s benefit costs under the bill’s formulas — a statewide figure that staff approximated as about $620 million annually — and said counties in North Carolina pay the non-federal share of certain costs, which could pass additional costs to counties if the federal rules changed. Staff characterized these numbers as early estimates and said state and county officials were still processing the proposal. Board members asked staff about state conversations and possible impacts to county budgets.
