Health Care Policy and Nonprofits

Last updated January 3, 2023

Rising health care costs are one of the biggest challenges for nonprofits and many of the communities and individuals they serve. Consequently, policies that would close systemic gaps in availability of quality health coverage - such as Medicaid expansion and improved options for employer-provided health insurance - are important to the nonprofit sector.


Medicaid Expansion

Currently, nearly half a million North Carolinians have incomes which are too high to qualify for Medicaid but do not have enough money to purchase their own private health insurance or to receive federal support to help pay for health coverage. With ever-rising health care costs, these North Carolinians in the coverage gap are turning more and more to nonprofits to meet many of their basic needs, such as health care, food, housing, and childcare. This problem exists because North Carolina remains one of final states that has declined the Affordable Care Act's option to expand Medicaid eligibility to many adults in this coverage gap.

  • Support Medicaid expansion in North Carolina. This would complement the work of many nonprofits by ensuring that hundreds of thousands of North Carolinians – including many employees and clients of nonprofits – have medical coverage.


Medicaid Transformation 

For several years, legislators and the NC Department of Health and Human Services (DHHS) have been attempting to convert the state’s Medicaid system to a managed care program (that emphasizes value-based care known as Medicaid transformation). Ultimately, Medicaid transformation should help continue the trend of heath care organizations working more closely with nonprofits that are focused on the social determinants of health.

  • Support legislation that will continue to provide adequate funding for the transition of NC’s Medicaid program to a system of managed care. A well-developed Medicaid transformation could lead to better coordinated investment in, and focus on, social determinants of health.


Association Health Plans

A state law enacted in August 2019 creates standards for association health plans (AHPs) in North Carolina. Currently, the NC Department of Insurance is not approving AHPs, which are ways for nonprofit associations to negotiate more affordable health insurance for multiple employers with some type of commonality of interest. Potentially, AHPs could create opportunities for nonprofits to offer more affordable, high-quality health insurance for their employees. However, nonprofit health advocates have expressed concerns that AHPs have the potential to create higher health care costs for some workers.

The Center has heard from many nonprofits that are interested in the creation of an association health plan open to employees of North Carolina nonprofit organizations. To help nonprofits understand more about association health plans, the Center has posted an updated analysis of the pros and cons of AHPs for the nonprofit sector.

  • Support policies that enable nonprofits to provide affordable, high quality health insurance for their employees. This may include new health care options for nonprofits and businesses or policies that
    would enable nonprofits to pool together to negotiate better health insurance options in a way that does not fundamentally harm the overall health care market.