By Jennifer Fernandez
In Guilford County, having an orange card means an uninsured dad who breaks his hand working around the house can get medical care.
It means a self-employed mom who no longer qualifies for Medicaid and can’t afford other insurance can get a mammogram.
Having one of those orange cards means that someone who’s living in a tent can see a dentist about an abscessed tooth.
Since 2002, more than 62,000 people living in Guilford County have received one of those orange cards from the Guilford Community Care Network, allowing them to access health care, according to executive director Sarah Dison. Guilford County has more than 562,000 residents, according to the latest census data.
The “Orange Card” program is one of about 30 Access Health safety net systems across North Carolina and South Carolina. Some, like the Orange Card, serve just one county. Others serve multiple counties.
Under some of these medical safety net systems, providers work out of a central clinic. Under others, like the care network’s Orange Card, patients can show their card to get care at various locations. It’s similar to a health insurance card, although providers are donating their services and receive minimal or even no reimbursement.
When North Carolina expanded Medicaid to include hundreds of thousands of low-income working adults, the Guilford Community Care Network thought hundreds of people on the Orange Card might qualify for the federal health benefits, Dison said.
Only about 50 did.
“It really underscored that even though Medicaid expanded,” she added, “there’s this need still growing for this population.”
Reaching the uninsured
About 10 percent of Guilford County’s adult population lacks health care coverage, according to the latest community needs assessment completed by Cone Health.
Not all of those people will qualify for the Orange Card, which requires participants to make no more than 200 percent of the federal poverty level. In 2026, that is $66,000 annually for a family of four.
The program is funded mostly by grants and individual donors — most of them local. Health care providers donate their time and services. There’s no state or federal government funding.
People ages 19 to 64 who don’t qualify for any other insurance program and meet the income guidelines can apply for the Orange Card, and they have to renew it every six months.
The network partners with providers throughout the county for primary care and specialty care. Some of that care is based in health systems, such as Cone Health, and some is with individual providers or clinics that donate their time and services.
Dental care became such a pressing need for the community that a dental program was added in 2005, Dison said. It is now their No. 1 referred service, she said, with 60 percent of Orange Card clients enrolled every year needing some dental care.
They also address social needs like food insecurity and access to transportation. Even though Guilford County is considered urban, there are large pockets that are more rural where transportation is an issue, Dison said. City buses don’t reach everywhere.
“Our clients report [transportation] is the biggest barrier as a whole for them,” she said.
Orange Card holders can use Uber Health, for example, to get to appointments and pick up medications.
The Orange Card doesn’t cover children. The expectation is that they would be covered by Medicaid, which covers all children up to just over 200 percent of the federal poverty level ($57,648 annual income for a family of three). But the program includes partners who will see children who don’t qualify for Medicaid. Those costs are on a sliding fee scale. That way, the entire family can be seen by one provider instead of being separated, Dison said.
Dison said they also work with some people older than 64 who don’t qualify for Medicare because they are undocumented.
Guilford County has a big immigrant population, driven in large part by its decades-long role as a refugee resettlement location.
Census estimates for 2020 through 2024 put Guilford County’s foreign-born population at 11.8 percent. That’s higher than the state’s foreign-born population of 9.1 percent during that same time period.
In Guilford County Schools, the third-largest school district in the state, students come from more than 142 cultural and ethnic groups and speak 118 languages — from Arabic and French to Spanish and Urdu.
Expansion in jeopardy
In January, more than 200 people applied for the Orange Card, one of the busiest months since Medicaid expansion went live in December 2023, Dison said.
Overall, expansion has added more than 720,000 people to the state’s Medicaid rolls. State data shows that 46,280 Guilford County residents gained coverage through Medicaid expansion.
However, a federal law passed in summer 2025 is expected to strip that expanded Medicaid coverage from tens of thousands of North Carolina residents.
Anywhere from 152,000 to 330,000 people in the state will lose coverage due to a combination of new work requirements and more frequent eligibility redeterminations to qualify for benefits, according to a new analysis by the Robert Wood Johnson Foundation and the policy think tank Urban Institute.
Starting in 2027, Medicaid expansion participants must prove they are working, volunteering or attending school for at least 80 hours a month to keep their benefits. They’ll also have to undergo those redeterminations every six months instead of once a year.
For Guilford County, under the best-case scenario, that translates to about 10,180 people who could lose health care coverage, according to a NC Health News analysis of state data.
Caseworkers with Guilford County Department of Social Services already refer people who don’t qualify for Medicaid to other programs, such as the Orange Card or Every Baby Guilford’s Adopt-A-Mom, which coordinates prenatal care for low- to medium-risk pregnant women.
Brittany Scott, an eligibility supervisor for Guilford County DSS, expects they’ll be sending more people to the Orange Card after the work requirement kicks in and people lose Medicaid for not meeting the hours.
Dison said her counselors are preparing for that as well.
“As they’re going through the recertification cycle of six months, maybe we’ll capture a large number of those individuals in the beginning as they’re kind of understanding what it means to qualify now,” she said.
Orange Card recipients are already on a six-month recertification period, and they’re also getting checked for Medicaid eligibility by Orange Card application counselors, Dison said.
“If at any point in this process they become eligible for Medicaid, we can help facilitate that process,” she said.
Dison expects people who lose Medicaid expansion in Guilford County will find their way to the Orange Card — at least for a while.
As people get used to how the new Medicaid requirements work, there will likely be more churn, “until they are able to establish a rhythm,” she said.
“It’s going to take some time to really figure out — what does that look like?” Dison said.
Cone Health, a longtime partner in the Orange Card, gathered stakeholders soon after the Medicaid changes were announced, Dison said. The hospital system wanted to know how to get the word out that the Orange Card is an option.
While the Orange Card has been available for decades, many people still don’t know about it, Dison said.
“If you’re in Guilford County,” she said, “we are here for you.”
Community effort
Dison recently joined a group of community organizations in Guilford County that have been working on ways to tackle the impending Medicaid changes.
Led by Friends in Action, a subcommittee at New Garden Friends Meeting, one issue they’re exploring is how to streamline some of the data that groups are processing.
“What if we came together and created something that was an easy screening to let them know, ‘Hey, we already looked, they’re not eligible for the Orange Card, but they are eligible for Medicaid or vice versa,’” Dison said. “So, [we’re] looking at the potential to partner and maybe share data in that type of way to help streamline the process, because it is a lot of information.”
Organizations are looking for areas of overlap.
Hospitals in Guilford County use software that shares data with the Guilford Community Care Network for anyone who goes to an emergency department and is flagged as uninsured or self-insured. Dison said the care network sends letters to those patients to let them know about the Orange Card — that it can provide them with a medical home, specialty care and dental care.
They’re working on updating those letters to include information about the Medicaid changes and how the care network can answer questions.
Friends in Action workgroups are looking at how to work with schools to help identify families who would qualify for exemptions from the new Medicaid requirements because their children have a disability. They’re working with local colleges to help students apply for benefits and looking at how to expand and coordinate food resources for people losing federal food benefits.
“We have a tremendous number of people who have retired from health care, nonprofit work, education — and we saw ways to knit those systems together in a way that might help with verification, outreach and whatnot,” said Jane Foy, a retired pediatrician who is part of Friends in Action. “We concentrated on the systems that we represented best within New Garden [Friends Meeting].”
Another key issue the workgroups are trying to address is logging volunteer hours. The Guilford Nonprofit Consortium and HandsOn NWNC are working on a volunteer database that would allow DSS caseworkers to easily track how many hours someone has accrued toward the new Medicaid work requirement.
“It’s a great first step in helping just put out all the opportunity out there,” Dison said. “Because there is a lot of opportunity in terms of volunteering, which is just one small aspect of … what may qualify for the work required hours.”
About this series
NC Health News reporters, with support from Public Health Watch, reached out to about a dozen counties across the state to discuss the impact of the new Medicaid work requirements. We conducted multiple interviews and spent several hours with county social workers to find out how they are preparing for the changes.
Read the previous stories
Day 2: Looming Medicaid work rules bring big challenges to NC counties
This story is part of “Uninsured in America,” a project led by Public Health Watch, a nonprofit newsroom based in Texas. The project focuses on life in America’s health-coverage gaps and the impact of potential Medicaid and related cuts.
KEEP UP WITH THE LATEST
Republish our articles for free, online or in print, under a Creative Commons license.
