NC SLP Spotlighted as Medicaid Cuts Impact Practices: ASHA Continues Push for Reimbursement Fixes

December 10, 2025

Across the country, speech-language pathologists (SLPs) are feeling the effects of recent Medicaid funding changes.

In October—despite extensive advocacy to raise Medicaid reimbursement rates by ASHA and the North Carolina Speech, Hearing and Language Association (NCSHLA)—North Carolina Governor Josh Stein initiated Medicaid cuts ranging from 3% to 10%. On December 10, Stein held a press conference rolling back those cuts. But the state still doesn’t have a budget—and North Carolina Medicaid will run out of money this spring if legislators do not pass an appropriate budget before then.

In a recent news segment, Stephanie Molina, an ASHA member and private practice owner in North Carolina, shared how Medicaid payment reductions are straining her ability to sustain operations, pay staff, and continue providing essential communication services to children and adults in her community. Her story is one example of the growing challenges triggered by changes within the One Big Beautiful Bill Act (OBBBA), the sweeping federal health and education law signed in July.

Understanding the Source of the Cuts

OBBBA shifts more of Medicaid’s financial responsibility to individual states, placing new pressure on state budgets and leading several to reevaluate—and in some cases reduce—reimbursement rates.

While the law aimed to streamline federal programs, states are now making difficult budget decisions. North Carolina is among the first to feel the downstream effects.

Opposing These Cuts From the Start

Throughout the legislative process, ASHA strongly opposed provisions in OBBBA that would reduce Medicaid payments or shift costs to states. We consistently raised concerns with Congress, submitted formal comments, and worked with coalition partners to warn of the risks these changes posed to patient access and provider sustainability. Although ASHA’s advocacy helped prevent large-scale changes to the Federal Medical Assistance Percentage (FMAP) and the adoption of per-capita caps, the bill still passed and included several harmful Medicaid policies.

See ASHA’s webinars:

Proposed Medicaid Funding Changes Ahead: What Audiologists and SLPs Need to Know (March 4, 2025)
How and When Upcoming Federal Policy Changes May Impact Audiologists, SLPs, and the People They Serve (July 29, 2025)

Working to Raise NC Medicaid Rates Before OBBBA Changed the Landscape

Prior to OBBBA becoming law, ASHA was working with NCSHLA to pursue long-overdue Medicaid reimbursement increases in the state. North Carolina’s rates had not kept pace with the cost of delivering care, and both organizations recognized the urgent need for action.

Together, ASHA and NCSHLA launched a series of coordinated advocacy efforts well before OBBBA’s passage, including:

April 2024: ASHA emailed all North Carolina-based members urging them to contact their General Assembly members in support of long-needed Medicaid reimbursement increases. Advocates sent more than 1,060 messages; however, the increase was not included in the state budget.
October 2024: ASHA and NCSHLA jointly developed and distributed a reimbursement survey to substantiate the need for increased rates. Findings were shared repeatedly with legislators through NCSHLA’s lobbyist and advocacy leadership team.
May 2025: ASHA again mobilized members, resulting in nearly 3,000 messages to state lawmakers calling for rate increases.
October 28, 2025: ASHA sent another action alert encouraging members to contact Governor Stein to reverse the cuts as a result of OBBBA, resulting in over 2,000 messages sent within the first few days.

These efforts laid the groundwork for increasing North Carolina’s outdated Medicaid rates—but the implementation of OBBBA, and the significant budget pressures it placed on states, ultimately derailed this progress. NC Medicaid specifically cited these policy changes in its announcement explaining the reasons for the (now reversed) cuts.

Because Medicaid is largely administered at the state level, ASHA continues to rely on and support NCSHLA’s state-based advocacy strategy. Providers can find more information about the state-driven structure of Medicaid in this ASHA resource: Medicare vs Medicaid: A Guide for Audiologists and Speech-Language Pathologists.

Why Stories Like This Matter

Molina’s interview puts a human face on the consequences of recent Medicaid funding changes. Policymakers often view Medicaid through a budget lens—but stories like hers reveal what numbers alone cannot:

Whether small practices can remain open;
Whether families can access timely, local care; and
Whether qualified clinicians can continue serving their communities.

Real-world experiences like this are critical for driving policy change. Stories from providers help illustrate for federal and state officials the urgent need for Medicaid reimbursement improvements.

Standing With Providers and Patients

ASHA continues to work every day to ensure that audiologists, SLPs, and the individuals they serve are not left behind as states implement OBBBA. The situation in North Carolina underscores why sustainable Medicaid funding is essential—not optional.

ASHA will keep pushing for solutions, and the voices of providers like Stephanie Molina remain among our most powerful tools for change.

If you have been affected by recent Medicaid changes and are willing to share your experience, please share your story with ASHA. Your stories help strengthen ASHA’s advocacy.