---
title: Health Department revenues up $6.3B, fueled by federal Medicaid money
description: <p>(The Center Square) – Total revenues have grown $6.3 billion in North Carolina’s Health Department, fueled by $6 billion from federal revenues in Medicaid, says an audit of fiscal year 2025 released </p>
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date: 2026-06-30T18:30:02Z
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(The Center Square) – Total revenues have grown $6.3 billion in North Carolina’s Health Department, fueled by $6 billion from federal revenues in Medicaid, says an audit of fiscal year 2025 released Friday.

North Carolina’s total enrollment in Medicaid is about 3.1 million, says the analysis from first-term Republican state Auditor Dave Boliek. The audit did not find any material errors for the Department of Health and Human Services led by Dr. Devdutta Sangvai.

The health insurance program for low-income and people in need is paid with county, state and federal tax dollars. North Carolina's population is an estimated 11.2 million, meaning about 1 in 4 are in the program.

Expansion of Medicaid was a long-sought battle in the state eventually won by former Gov. Roy Cooper, the Democratic candidate for U.S. Senate this election cycle, against Republican majorities in the General Assembly. To get it done, a Sept. 22 agreement on the state’s two-year budget in 2024 – later than the July 1 date in statute – had one bill for Medicaid expansion, and a separate bill for the state budget with Republicans saying the expansion would not happen without the budget becoming law.

Cooper allowed the $60.7 billion two-year spending plan, after the required 10 days, to become law without his signature rather than signing it. A key reason was North Carolina adopted universal school choice through the bill.

In the positive of expansion, an immediate automatic increase of [Medicaid enrollments](https://www.auditor.nc.gov/documents/reports/financial/fin-2025-4400/open) was 272,937. These were part of the family planning population automatically moved to full coverage.

Medicaid remains an issue in the General Assembly, from critically objective audits to suspected fraud to use as a political pawn between the two major parties that can no longer show measurable increase in voter registrations.

For example, first-term Democratic Gov. Josh Stein in November tried to call the General Assembly back into session for the purpose of funding Medicaid. Sen. Phil Berger, R-Rockingham, president pro tempore of the chamber, said the Health Department led by a Stein appointee confirmed the program was indeed funded through April and said the governor and secretary only needed to pause Medicaid reimbursement rate cuts.

Stein in early December reversed rate cuts of 3% to 10% that began Oct. 1 for doctors, hospitals and other medical providers of Medicaid services. The rebase of $319 million was legislatively passed and signed into law by Stein in April.

Two months ago, Boliek’s office said Medicaid at $24.7 billion accounted for more than half of $43.9 billion in expenditures of federal awards for fiscal year 2025. That audit, among eight issues found tied to the Health Department, found subawards on two occasions to counties totaling $138.8 million were not reported as required.

Boliek’s staff is digging deeper into Medicaid, with particular interest in spending for autism therapy.

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