Medicaid in North Carolina has been in poor financial shape for decades. After the pandemic, North Carolina intentionally decided not to check the eligibility of nearly all of its Medicaid recipients. For all we know, there could have been hundreds of thousands of ineligible people receiving Medicaid in North Carolina. Even before North Carolina expanded Medicaid eligibility, the state had the highest rate in the country of able-bodied Medicaid recipients who were not working. No one, whether Republican or Democrat, would deny that North Carolina’s Medicaid program is in rough financial shape.