Steve Ha didn’t anticipate drawing statewide attention when he set out to calculate the local economic impact of SNAP and Medicaid funding for the Jackson County Department of Social Services (DSS) in Sylva.
The Western Carolina University economics professor said he was shocked when people in Raleigh started reaching out.
“Why do they contact me?” Ha said, still a little dumbfounded. “I mean, I’m like 300 miles away, and there are major R1 universities in that area. I was surprised because I didn’t check all the studies and literature before I started to do the work, but all of a sudden, I realized that this is a significantly underdeveloped area.”
Jackson County DSS Director Cris Weatherford provided Ha with the necessary data. In return, Ha produced a study which found that SNAP and Medicaid dollars have an estimated $144 million economic impact in Jackson County alone. That impact supports 1,211 jobs, generates $61 million in labor income, and produces $18.9 million in federal, state, county, and subcounty tax revenues.
In fiscal year 2025-2024, Jackson County DSS Medicaid and SNAP expenditures totaled to $110 million and $9.8 million respectively, the vast majority of which came from federal dollars. By comparison, state and county dollars amounted to $27 million and $4.8 million, respectively, of the department’s $130 million budget.
Weatherford was looking for a way to better illustrate the economic impact of federal benefits while putting together the department’s annual report. With Ha’s research, he hoped to convey just how important these programs are to the entire community, not just the people receiving benefits.
“When you’ve got a really divided political situation, and you start seeing these programs getting cut or in danger of people losing (coverage), it’s easy for us to see in our office what a 20% decline in Medicaid would look like,” Weatherford said. “But to explain that to a community and how that’s going to impact the community is something we’ve really wanted to try to do in a meaningful way.”
Ha and Weatherford found plenty of meaning in the numbers.
Ha likes to think of economic impact as a footprint. It’s not only the money injected into an economy, but also the economic activity that money generates.
That includes the capacity of a hospital, the number of grocery stores in a county, additional tax revenue in county coffers, and a little extra wiggle room in a parent’s budget. Then there’s the multiplier effect: What happens when one dollar spent in the local economy gets spent again and again?
A nursing home hires more employees. An employee buys a meal at a local restaurant. Somewhere down the line, a farmer gets paid. The money keeps moving, generating economic activity well beyond its initial destination.
Those secondary impacts may not be immediately visible, Ha said, but they benefit everyone, regardless of income.
One common misconception, he said, is that SNAP and Medicaid are programs that only benefit poor people.
“SNAP dollars, they go to groceries — Walmart, Ingles. I can find fresh vegetables. I can take benefit,” he said. “People don’t care, probably don’t know about SNAP, Medicaid. (They think) those kind of federal subsidies are just for poor people with disabilities and all kinds of stuff. Not me. That’s not true. That’s not true.”
In rural North Carolina, where resources are often scarcer, Medicaid and SNAP are especially important economic lifelines.
According to the N.C. Department of Health and Human Services, SNAP and Medicaid enrollment as a percentage of county population in The Smoky Mountain News coverage area is:
- Haywood County: 10.5% SNAP and 28.5% Medicaid
- Macon County: 8.2% SNAP and 25.6% Medicaid
- Jackson County: 8.1% SNAP and 24.5% Medicaid
- Swain County: 12% SNAP and 49.9% Medicaid
Swain County ranks fifth statewide for the highest percentage of residents enrolled in Medicaid.
Ha’s intention was to make clear that federal benefit dollars affect everyone in a community, whether they realize it or not. Now, with sweeping changes to both programs on the horizon, that economic footprint could look considerably different.
A new deadline looms
For Weatherford, a typical annual report to the Jackson County Board of Commissioners includes updates from the most recent fiscal year, like how many children are in foster care (61), how many residents receive Medicaid benefits (11,695), and how many households received energy assistance (1,279).
This year, however, another set of numbers is looming over the department.
Beginning Jan. 1, 2027, major changes to Medicaid eligibility and administration under HR 1, also known as President Donald Trump’s One Big Beautiful Bill Act, will take effect. Other provisions affecting SNAP have their own implementation timelines. Together, the changes are expected to reduce the number of people receiving benefits and the amount of federal money flowing into communities like Jackson County.
Under the new Medicaid rules, most adults ages 19 to 64 will have to complete 80 hours per month of work, school, job training or community service, or earn at least $580 per month to maintain coverage. Certain groups are exempt, including people with disabilities, pregnant people, and caregivers and parents of young children.
The changes also include:
- Medicaid eligibility renewals every six months instead of annually for affected adults.
- A reduction in retroactive Medicaid coverage from three months to one month for the Medicaid expansion population.
SNAP eligibility rules are also changing. The age range subject to existing work requirements expands from 18 to 54 to 18 to 64. Adults who do not meet the requirements or qualify for an exemption can receive SNAP benefits for only three months in a 36-month period.
Some previous exemptions are also being eliminated, including those for veterans, people experiencing homelessness, and certain young adults who have aged out of foster care.
By 2034, the Congressional Budget Office (CBO) estimates that HR 1’s health provisions will reduce spending by $1.3 trillion due to SNAP, Medicaid, and Affordable Care Act Marketplace cuts.
Supporters of the changes argue they are not really cuts. Instead, they say the new eligibility requirements will remove people who shouldn’t be receiving benefits in the first place; it’s part of the Trump administration’s broader effort to eliminate what it calls waste, fraud, and abuse.
Opponents argue the changes will shift costs to states, strain state and local budgets, slash healthcare jobs, put rural hospitals at risk, and cause otherwise eligible adults and children to lose coverage because of additional administrative hurdles.
In June 2025, just one day after voting against HR 1, Republican Sen. Thom Tillis delivered a scathing critique of the bill’s Medicaid provisions on the Senate floor. The same day, he announced he would not seek reelection.
“What do I tell 663,000 people in two years or three years when President Trump breaks his promise by pushing them off of Medicaid because the funding is not there anymore, guys?” Tillis said. “I think the people in the White House, those advising the president, are not telling him that the effect of this bill is to break a promise.”
In North Carolina, estimates of the potential impact have been substantial. As many as 255,000 people are projected to lose Medicaid coverage, while as many as 143,000 North Carolinians could lose access to food assistance under these changes, according to the N.C. Budget and Tax Center.
Marianne Hedrick Weant, director of programs for the North Carolina Alliance for Health, reached out to Ha after learning about his study. She wanted to discuss expanding the research to all 100 counties in North Carolina.
“The study was really cutting-edge in the sense that it was able to take a really big question and drill down into one local county and say this is what we are seeing here,” Weant said. “It’s not enough to pass a policy or have a program in place. We should be looking at if it’s fulfilling what we think it was going to fulfill, and that was in jobs hired. It was in local expenditures.”
Ha’s study showed the ripple effect of federal SNAP and Medicaid dollars in Jackson County. Now, experts like Weant are concerned about the ripple effect of their absence.
One of the most immediate consequences could be less food on families’ plates, said Kate Hanson, founder and executive director of Meals4Families.
In North Carolina, SNAP and Medicaid participation automatically connects children to free or reduced-price school meals through a streamlined process called direct certification. Losing that automatic connection is one way children could lose access to assistance, even if their families remain eligible.
“HR 1 isn’t supposed to change SNAP access for kids, but the data shows it does because paperwork is not neutral,” Hanson said, pointing to the administrative burden placed on county DSS offices and local families. “It determines who gets through and who gives up.”
As verification requirements multiply under HR 1, Hanson fears eligible families will simply fall through the cracks.
“They’re missing out and falling off SNAP benefits, and it’s not because their need has changed,” Hanson said. “It’s not because childhood food insecurity rates have improved. It’s really a reflection of that paperwork burden.”
Hanson said research from Child Health Watch underscores the severity of the problem: A child losing SNAP benefits should be treated with the same seriousness as a child losing access to medication because it’s on the same magnitude of harm.
And the consequences of that paperwork burden don’t stop at the school lunch line or the dinner table.
The CBO projects that HR 1 will cause millions of children to lose Medicaid coverage nationwide. While the law does not directly change children’s eligibility for Medicaid or the Children’s Health Insurance Program (CHIP), confusing rules, additional paperwork, and fear could discourage parents from seeking benefits for which they and their children remain eligible.
Children of immigrants represent one in four children nationally and one in five in North Carolina. Public health advocates say even lawfully present families who remain eligible under HR 1 are opting out of SNAP and Medicaid because they fear applying could jeopardize future citizenship applications or attract unwanted attention from immigration enforcement.
And while HR 1’s potential impact on children is alarming, the consequences extend well beyond just that vulnerable population.
Weatherford said when people lose benefits, the costs don’t simply disappear. Investing in healthcare up front prevents expensive interventions in the long run, such as emergency room visits and treatment for diseases that have progressed without adequate care.
“That stuff typically drives up everyone else’s health insurance and hospital costs,” Weatherford said. “The cost is going to hit somewhere, right? Nothing either disappears or is created on the planet. It’s going to happen somewhere.”
The changes also create challenges for the people responsible for administering these programs. Weatherford said it is difficult for both individuals and caseworkers when someone loses healthcare coverage and can no longer afford to manage a child’s special needs or chronic condition, such as diabetes.
Waste, fraud, and abuse
House Speaker Mike Johnson has advocated for HR 1’s changes to cut down on waste, fraud, and abuse while helping demographics like able-bodied young men find dignity and self-worth through employment.
“What we’re doing is strengthening Medicaid and SNAP so that they can exist, so that they’ll be there for the people that desperately need it the most, and it’s not being taken advantage of,” Johnson said in May 2025 on CBS News’ Face the Nation. “And this is something that everybody in Congress, Republicans and Democrats, should agree to.”
But in states that have already implemented Medicaid work requirements, administrative costs have sometimes outpaced actual spending on healthcare, begging a question; Who gets to waste money and what is considered abuse?
ProPublica reported in September 2025 that Georgia’s Medicaid work requirement program had spent twice as much on administrative costs as on healthcare, according to a Government Accountability Office report.
The program was implemented in July 2023, as of April 2025, Georgia had spent $54.2 million on administrative costs for the work requirement program, compared to $26.1 million on healthcare. Ninety percent of the administrative expenditures came from federal tax dollars, according to the report.
ProPublica also reported in May 2025 that Georgia awarded Deloitte Consulting a $10.7 million marketing contract for marketing the Medicaid program. By August 2025, subsequent reporting found that only 9,175 of approximately 250,000 eligible Georgians had enrolled.
A September 2025 study found that Georgia’s Medicaid work requirement program had no measurable effect on the state’s employment rate.
In North Carolina, meanwhile, lawmakers have had relatively little to say about the rising cost of Equifax, a company the state contracts to assist with income verification for Medicaid and Food and Nutrition Services, also known as SNAP. North Carolina’s payments to Equifax nearly doubled to $22.5 million in 2025, compared to $11.6 million in 2022, according to The New York Times.
Few companies can compete with Equifax’s products, and in a February 2026 letter, three Democratic senators accused the company of price gouging and called for greater scrutiny of its business practices.
As administrative costs rise and government contractors stand to benefit, still, congressional leaders like Johnson remain focused on individual benefit recipients as the primary abusers of the system.
“The largest source of SNAP fraud is very well known, and it’s actually criminal entities who are stealing benefits from eligible families,” Hanson said. “It’s something called SNAP skimming. Far, far more money is lost through SNAP benefits theft than through payment errors that result largely from unintentional mistakes, or from true program fraud.”
She questioned what the government is doing to help states prevent SNAP benefit theft.
Weant echoed Hanson’s concerns, arguing that HR 1 focuses on the wrong areas when it comes to reducing unnecessary spending.
“Everyone wants to be paying for programs that work and programs that are doing what they’re supposed to do that have low rates of fraud,” Weant said. “Everyone wants that, but this doesn’t get us there.”
Where HR 1 does lead, Weant fears, is somewhere much harder to recover from.
When people fall off public benefit programs, getting them back on can be difficult. Someone might not have the necessary paperwork in order, and by the time they satisfy the new eligibility requirements, months may have passed since their last doctor’s appointment.
Even if HR 1 were overturned tomorrow, Weant said, the consequences could linger.
These programs have long been a reliable safety net for people when they need it most. What happens when that reliability disappears?
Someone already struggling to get by may have to decide whether it’s worth gathering all the necessary documentation or whether it would be easier to visit the local food pantry. But food pantries simply aren’t equipped to meet widespread household grocery needs at the same scale as the federal government.
Part of Weant’s job is meeting with state lawmakers and advocating for policies that support the health of North Carolinians. State legislators cannot change the provisions of HR 1, she said, but they do control the state’s pursestrings. And lawmakers on both sides of the aisle appear concerned about what comes next.
“I think that we saw this, even in some of the committee meetings in this last General Assembly session, as people were digesting the impact of HR 1, they’re kind of like, ‘Oh my god. Like, I didn’t realize it was going to do that,’” Weant said. “And that’s because it’s, what, thousands of pages long? It’s really hard for people at the state level to know exactly what’s going to happen at the federal level.”
Weant and the N.C. Alliance for Health spent years organizing to get Medicaid expansion passed in North Carolina. That effort took the better part of a decade. With midterm elections approaching and a new class of lawmakers set to join the General Assembly in 2027, time will tell how it responds to the challenge.
Research like Ha’s Jackson County study could prove crucial in building the political will to maintain North Carolinians’ access to these programs.
As more of HR 1’s provisions take effect, those who understand the stakes hope Ha’s study will serve as more than just proof that North Carolinians didn’t know what they had until it was gone.