According to Guilford County Social Services Director Sharon Barlow, the “One Big Beautiful Bill,” which is now the One Big Beautiful Law, is projected to “significantly” impact Medicaid in Guilford County and North Carolina in ways that are very worrisome to local and state leaders.
That impact, Barlow told the Rhino Times, will come primarily through cuts to federal funding and the implementation of work requirements for able-bodied adults.
The changes are expected to lead to a reduction in Medicaid coverage for many North Carolinians, and could, she said, “destabilize” the state’s healthcare system – particularly when it comes to rural hospitals.
Advocates of the bill argue that the thrust of the effort is to see that all those who can work do work – or provide community service – in order to be eligible for the benefits. Opponents, on the other hand, argue that it will provide so much red tape that people who are legitimately entitled to benefits will be unable to receive them due to an inability to navigate the more complicated bureaucratic system.
There’s also the concern that some rural hospitals across the state and the country will close due to a lack of Medicare business and funding.
Chairman of the Guilford County Board of Commissioners Skip Alston told the Rhino Times that he is concerned the bill will increase costs that have to be paid by county government since it may require additional county staff to conduct more frequent eligibility checks, as well as to fill out other forms necessary to implement the new restrictions. On the other hand, one county social services employee who has studied the bill said it will likely cause so many county residents to lose Medicaid services that the county may actually end up needing fewer social services workers in the future due to a major decline in the number of people receiving Medicaid.
One person concerned about the implications of the bill for the health of county residents is Barlow, who leads the social services division for Guilford County and who has spent the last several years overseeing Medicaid expansion for Guilford County government.
In responses to questions from the Rhino Times, Barlow listed her concerns as follows:
“1. Reduced Federal Funding: The OBBBA [the big bill] is expected to cut federal Medicaid funding, which could force North Carolina to reduce or eliminate optional Medicaid benefits, including home- and community-based care for people with disabilities. This could negatively impact access to care for vulnerable populations, including those with disabilities and those relying on home-based care.”
Barlow said the work requirements in the new legislation will knock a lot of people off Medicaid. While many conservatives say that’s just fine, others argue that the health system will see increased cost because the health care provided to the uninsured will ultimately be borne by taxpayers. The big bill, Barlow points out, mandates work requirements for most able-bodied adults on Medicaid, requiring them to prove they’re working, attending school or volunteering for at least 80 hours a month.
“2. State officials estimate that these requirements could lead to the loss of coverage for over 255,000 North Carolinians,” Barlow added, “with some potentially losing coverage due to red tape and paperwork rather than unemployment.”
Like Alston, Barlow is very concerned about the cost to Guilford County, which is already in dire financial straits due to more than $3 billion in school bond debt and a wild spending spree on anything and everything that’s taken place over the last five years.
“Implementing these requirements will require a costly and complex system to verify beneficiaries’ employment status adding additional work to an already overburdened county system,” Barlow told the Rhino Times.
Here are some of her other concerns:
‘3. Impact on Hospitals and Rural Communities: Cuts to Medicaid funding could disproportionately affect rural hospitals, which often rely on Medicaid revenues to stay afloat.
The loss of Medicaid funding could also reduce access to care for all North Carolinians, regardless of their insurance status.
- Eligibility Changes: The OBBBA also includes provisions that could limit Medicaid eligibility for certain non-citizens.
This could result in a decrease in Medicaid coverage for some lawfully present immigrants, including refugees, asylees, and victims of trafficking.
- Potential for Medicaid Unraveling: The bill’s provisions, including work requirements and funding cuts, have the potential to significantly destabilize North Carolina’s Medicaid expansion and could lead to an unraveling of the program.”
In summary, she said, the bill’s impact on Medicaid in North Carolina is expected to be “far-reaching, with potential consequences for access to care, the financial stability of hospitals and healthcare providers, and the overall well-being of vulnerable populations reliant on the program.”
The bill will also affect the SNAP program in Guilford County, Barlow told the Rhino Times. That stands for Supplemental Nutrition Assistance Program – a program that used to be known widely as food stamps. In Guilford County, 41,326 households were recipients of Snap funding as of June 2025..
Barlow wrote: “The ‘One Big Beautiful Bill Act,’ now law, will significantly impact SNAP in North Carolina, likely leading to increased food insecurity and financial strain on families. Key changes include cost-shifting to the state, stricter work requirements, and potential benefit cuts. More than a million North Carolinians are food insecure, including 1 in 6 children. Four out of five families participating in SNAP in NC have either a child, a senior or an adult with a disability. Between 2019-2023, an average of 80 percent of SNAP households in NC included someone who is working. More than 46,000 NC Veterans benefit from SNAP.”
Barlow said that cuts to SNAP benefits – combined with rising food costs – are “likely to exacerbate food insecurity and poverty” across the state.
