By Will Atwater, Jaymie Baxley, Anne Blythe, Rachel Crumpler, Jennifer Fernandez, Rose Hoban and Taylor Knopf

Making predictions in the current political and social environment — particularly about health care — can be a tricky business. As the great Yogi Berra quipped, “It’s tough to make predictions, especially about the future.”

Case in point, who heard of ChatGPT at the beginning of 2022? By now, though, the promise and potential peril of artificial intelligence now drives many individual decisions as well as public policy. 

Our reporters, however, have their fingers on the pulse of what’s happening in health care and health policy in North Carolina and have a good idea as to what’s in store, at least in the near term. 

So, here’s what we’ll be watching in the year ahead. 

Following the child welfare system

North Carolina has been working to improve its child welfare system, and we’ll be tracking its progress in the coming year. A big part of that is being able to follow child welfare cases across counties, something that’s long been on the wish lists of advocates and child welfare workers.

In 2026, the state will continue rolling out a case tracking system it designed with the help of workers in the field. The Partnership and Technology Hub, or PATH NC, launched in 15 counties on June 2. By the end of 2025, all but 11 counties were using the new system for intake and assessment. 

The goal is to have all counties using PATH NC for full case management by the end of 2026, Lisa Tucker Cauley, director of human services for the North Carolina Department of Health and Human Services, told NC Health News.

Once it is fully implemented, PATH NC will let the county Departments of Social Services handle intake, assessment, in-home services, foster care, adoption, financials, licensing and eligibility.

The 11 counties not yet on PATH NC are using a different automated system, which means for the first time, North Carolina can see intake and assessment information for any child in the system, no matter where they are in the state, Cauley said.

Cauley said PATH NC was built not just based on what is needed for automation, but what is needed to support the workforce in “doing good work with children and families so they have better outcomes.”

However, without the ability for full ongoing case management across the entire state, North Carolina still doesn’t meet federal reporting requirements, she said. 

The software rollout has gone well, and feedback remains positive, according to Cauley.

“We’re also hearing good things that the system creates … efficiencies for workers, which is what we wanted in a system,” she said.

North Carolina has made a series of moves in recent years to improve the child welfare system, from creating a regional support system and adding new workforce training and supports, to investing in evidence-based prevention services and providing more support for families through programs like the Bridging Families foster program. In December, the state enrolled 32,000 former foster youth and children in foster care in a new Medicaid program that allows health care services to follow the child as they move around the state, preventing disruptions in care. 

The overhaul is a result of Rylan’s Law, named for 3-year-old Rylan Ott, whose tragic 2015 death in Moore County compelled lawmakers to make drastic changes to the state’s child welfare system.

“What’s most important to know is child welfare has been, since Rylan’s Law, on a path of transformation,” Cauley said. “This system is a part of that.”

— Jennifer Fernandez

Whooping cough cases top 800 for second year in NC

Just this week, NC DHHS announced that an unvaccinated child has a presumed case of measles after visiting South Carolina, where an outbreak of that disease has been spreading. The question is whether the state will see outbreaks of this and other vaccine-preventable diseases in the coming year.

Already one formerly-common childhood disease has been making a comeback in North Carolina. We’ll be watching whooping cough cases to see if they start to drop after two years with more than 800 people catching the highly contagious respiratory illness in North Carolina. 

Whooping cough, also known as pertussis, rises and falls in cycles as vaccines wear off and new children are born without immunity, experts said. Vaccination coverage also plays a role. In North Carolina, vaccination coverage for whooping cough in many counties falls well below the 92 percent to 94 percent level that health officials say is important to help stop it from spreading among a community.

The illness has been on an upswing, with cases rising across the state and nation in 2023 and 2024. 

Nationally, cases began falling in 2025, although they are still higher than pre-pandemic levels. There have been 27,871 cases in the United States through the week ending Dec. 20, according to the Centers for Disease Control and Prevention. The previous year, there were 41,922 cases through the same period.

However, federal data is preliminary and sometimes identification lags well behind state tracking. For example, Texas is reporting more than 3,500 cases through October 2025. Federal data shows only 1,392 cases in Texas through Dec. 20.

The South Atlantic region, which includes North Carolina, has more cases than last year at this time, federal data show. Most of that is driven by Florida, where cases have more than doubled compared with last year. Florida’s vaccination coverage for whooping cough sits at about 89 percent for school-aged children, according to federal data.

In North Carolina, cases skyrocketed to 831 in 2024 from 109 the year before, according to state data shared by NC DHHS. 

Cases in 2025 had already topped the total for 2024 with two weeks left in the year. There were 883 cases as of Dec. 12, the latest state data available.

Whooping cough is caused by the bacteria Bordetella pertussis, and it causes an infection that can be life-threatening, especially for infants. Babies are particularly vulnerable because their tiny airways — smaller than the width of a pinkie finger — can collapse after a bout of coughing. Babies also get sick with whooping cough at higher rates than older children. 

Half of all of North Carolina’s 2025 cases are in children age 9 or younger, state data show. 

The rate among infants is 2.7 times higher than among school-aged children, NC DHHS said. There are 70.1 cases of infants with whooping cough per 100,000 residents. For school-aged children, the rate is 25.6 per 100,000 residents.

— Jennifer Fernandez

More changes ahead for reproductive, gender-affirming health care?

In recent years, patients have had to adjust to new restrictions on abortion access and gender-affirming care for minors — changes that in some cases have compelled North Carolinians to seek care out of state. More limits could be on the horizon in 2026 as the Trump administration signals a continued focus on regulating abortion and gender-affirming care. 

We are watching federal actions that could affect North Carolinians, including challenges to “shield laws,” which allow licensed clinicians to provide abortion care — including abortion pills prescribed through telehealth — regardless of where a patient lives. Hundreds of North Carolinians, along with thousands more patients nationwide, receive abortion pills through out-of-state telehealth providers operating under these laws, according to #WeCount data collected by the Society of Family Planning. 

These laws have facilitated expanded abortion access, and critics are ramping up efforts to restrict this pathway to care and to curtail telehealth-based abortion access.

Additionally, the Centers for Medicare and Medicaid Services in December unveiled a proposed rule that would bar hospitals that participate in Medicaid and Medicare from providing any gender-affirming care to youth — a change that could sharply restrict access in most hospitals.

North Carolina law already prohibits gender-affirming care for minors, with limited exceptions for patients who were already receiving care when the state’s 2023 law took effect. Atrium Health halted this care for patients under age 19 in August, leaving some families scrambling for alternatives. 

If more hospitals follow suit, options for gender-affirming care — which major medical organizations consider best practice — will become even more limited, including in states that haven’t enacted their own restrictions. 

Advocates also worry that further policy changes could potentially entangle access for adults.

— Rachel Crumpler

NC prisons face staffing shortages, aging population as reentry work continues

North Carolina has established an ambitious plan to improve support for people leaving prison by 2030. Last year, first lady Anna Stein named reentry and rehabilitation as one of her priority issues during her husband’s time as governor, adding momentum to the effort. As 2030 approaches, we will be closely tracking progress made toward the goals — and the obstacles in its way. 

Chief among the challenges are persistent staffing shortages at the N.C. Department of Adult Correction that limit the agency’s ability to provide programming to the state’s incarcerated population of more than 32,000. 

Since April, prison admissions have outpaced releases, swelling the prison population by roughly 1,400 people in 2025, Secretary Leslie Cooley Dismukes told lawmakers during a Dec. 17 meeting of the House Select Committee on Involuntary Commitment and Public Safety. 

Health care staffing is especially strained, with about 48 percent of prison nursing positions vacant, Dismukes said. At the same time, North Carolina’s prison population is growing older, driving increased need for medical care that will test the department’s resources and budget. The department projects a $63 million medical budget shortfall in fiscal year 2025-26, continuing a trend of rising health care costs. We will be examining how the department addresses these pressures — and what they mean for reentry efforts and prison conditions.

— Rachel Crumpler

Is NC ready for Medicaid work requirements?

Many Medicaid beneficiaries will soon be subject to a new rule requiring them to prove they are working, volunteering or attending school for at least 80 hours a month.

While the controversial change — a provision of the One Big Beautiful Bill Act signed into law this summer by President Donald Trump — includes exemptions for seniors, pregnant women and people with disabilities, an untold number of “able-bodied” North Carolinians ages 19 and older are likely to lose coverage — not because they are unemployed, but because of paperwork issues.

Most of the state’s non-exempt Medicaid recipients already have jobs, according to the N.C. Department of Health and Human Services. But technological limitations, language barriers and other challenges could prevent many from regularly submitting the documentation needed to confirm their employment status.

There are other concerns. Jay Ludlam, head of Medicaid for North Carolina, has said the state must develop a costly new system to implement the requirement. That expense will not be covered by the federal government, saddling North Carolina with an unfunded mandate.

Even after that system is in place, the day-to-day work of administering the requirement will largely fall on local and county departments of social services, which are already grappling with staffing shortages and large backlogs of cases.

If all that weren’t enough, Ludlam and other state officials have warned that the new work tracking requirement could trip a trigger law forcing North Carolina to unwind its 2023 expansion of Medicaid. The roughly 700,000 people who gained coverage through expansion could lose it overnight unless the General Assembly modifies or repeals that trigger.

North Carolina has just one year to prepare. Interim federal guidance is expected from the U.S. Department of Health and Human Services in June, and states are required to begin outreach to beneficiaries in September. The work requirement is set to take effect on Jan. 1, 2027.

In the coming months, we’ll be closely following how state leaders, county agencies and advocacy groups respond — and whether North Carolina can implement the new mandate without disrupting coverage for hundreds of thousands of people.

— Jaymie Baxley

Following ongoing challenges in the environmental space

Per- and polyfluoroalkyl substances (PFAS), commonly known as “forever chemicals,” are poised to remain a major environmental health issue in 2026. After a year marked by emerging research and regulatory uncertainty, NC Health News will keep tracking how federal policy decisions, court cases and scientific findings shape the future of PFAS oversight.

In 2025, NC Health News reported on the U.S. Environmental Protection Agency’s proposal to revise PFAS reporting requirements, as well as on new research showing that hard-to-detect PFAS “precursors” can transform into regulated forever chemicals during the water-treatment process — findings that raised new questions about how much contamination may still be going undetected.

That debate is likely to intensify in the year ahead. The EPA is expected to finalize its PFAS reporting standards in 2026, and lawsuits tied to PFAS contamination and accountability are winding through the courts.

PFAS are a broad class of chemicals used in consumer products that persist in the environment and the human body. In North Carolina, the issue has drawn heightened attention since 2017, when decades of PFAS discharges from the Chemours Fayetteville Works plant into the Cape Fear River were revealed.

A Dec. 18, 2025, speech by Emily Donovan, co-founder of Clean Cape Fear, to a House Environment Subcommittee hearing on PFAS underscored what advocates say is at stake as the federal government weighs its next moves.

“I raised my children on this water because I thought it was good for them — water should be good for children,” Donovan said. “I watched my husband survive a brain tumor. I also buried friends my age who shared their illnesses with this very room seven years ago. Some of us don’t have the luxury of time to keep redirecting the focus away from real solutions.”

Other storylines NC Health News will follow in 2026 include the growing conflict between environmental advocates and industry over data centers, as well as the potential loss of millions of acres of wetlands as the federal government revises the definition of Waters of the United States.

The Trump administration has signaled strong support for rapid data-center expansion, even as environmental advocates warn about the facilities’ heavy demands on water and electricity. In 2023, the U.S. Supreme Court’s decision in Sackett v. EPA narrowed federal protections for wetlands to those with a continuous surface connection to navigable waters. In November 2025, the EPA and the U.S. Department of the Army proposed a rule change to formally implement that decision.

If the rule is finalized, critics warn that many wetlands in eastern North Carolina could be opened to development, increasing the risk of flooding and water-quality degradation. The public comment period closes on Jan. 5, 2026.

How environmental rules are enforced on the ground in North Carolina will be another key issue to watch in the year ahead. As development pressure grows and federal protections are narrowed, legal challenges are expected to play a central role in shaping what environmental safeguards actually look like.

In December, Sound Rivers and the Southern Environmental Law Center announced a settlement to stop sediment pollution from a residential development affecting Martin Branch and Hurricane Creek in Durham. The developer will pay $270,000 to the Triangle Land Conservancy to purchase and protect a 62-acre tract in the Lick Creek watershed upstream of Falls Lake, a drinking-water source for Raleigh, along with $30,000 in civil penalties and $50,000 in attorney fees, according to a release. 

Sound Rivers Neuse Riverkeeper Samantha Krop says protecting land in this fast-growing area of southeast Durham is crucial to safeguarding downstream water quality.

“We hope that this settlement serves as a powerful deterrent to bad actors who recklessly harm our waterways with irresponsible construction practices, and an unambiguous warning that pollution of our waterways will be met with serious legal and financial consequences.”

— Will Atwater

Mapping mental health care for complex needs

People often reach out to me with a similar story: They have a loved one with complex mental health needs. They’ve tried repeatedly to find help for them, but nothing seems to work. They’ve called mobile crisis teams to their house. They’ve made trips to the emergency room. They’ve secured involuntary commitments, which led to short psychiatric hospital stays. Sometimes their loved one’s circumstances — such as delusions, hallucinations or homelessness — make them harder to reach. Other times people have found previous treatment to not be helpful, and now they refuse all help.

Meanwhile, family members live in constant fear and exhaustion, worried about safety and unsure what to do besides wait for the next emergency.

In 2026, I plan to write a series of stories that asks a simple but urgent question: What help actually exists for people with the most complex needs in North Carolina and how do you access it? I’ll be digging into the services that are often mentioned but rarely explained, from tailored Medicaid plans, to ACT and FACT teams, to early psychosis programs and peer support. I’ve been talking with health leaders about what services their organizations provide and how to access them. If you have something you want to share, please reach out to me at tknopf [at] northcarolinahealthnews.org. 

I want this series to be practical and focused on the “how-to” details families are desperate for: where to start, who to call, what paperwork do you need, and what realistically helps people engage in care. It will also look at what’s missing — like supportive housing, to name a big one — and why some effective services are so hard to find. 

Along the way, I’d like to share profiles of people in mental health recovery and what made a difference for them. (If you’re reading this and that’s you — send me an email.) The goal is not to pretend the system works perfectly (it doesn’t), but to map what’s there, who it’s for and how families can navigate it with more clarity. This series won’t answer every question or offer a solution for every situation — no news article could — but I’d like to give people a clearer sense of what might be available to them and where to begin. 

In addition to this series, I will also be paying attention to the new House Select Committee on Involuntary Commitment and Public Safety, which aims to study the involuntary commitment process and make administrative and policy recommendations to improve it. The committee has met twice. The next meeting is scheduled for Jan. 14, and it can be viewed online. (All of the presentation materials are also at the link.) 

— Taylor Knopf

Will gridlock prevail at the NC legislature? 

Legislators are scheduled to return in early 2026 for the short session — which traditionally is used to adjust the biennial budget — but it’s not clear whether any budget deal will materialize as chambers continue to jostle over priorities.

There was a lot of change in the General Assembly in 2025. Former Speaker of the House of Representatives Tim Moore was elected to Congress, leaving space for the first new speaker in a decade. That seat was filled by Destin Hall (R-Lenoir), a fifth-term representative from Caldwell County. 

Hall put his stamp on policy early by refusing to budge on some of his priorities. This led to a showdown with Senate leader Phil Berger (R-Eden), and for the first time in memory, the two chambers were unable to reach any compromise on a state budget.  North Carolina is the only state in the U.S. without a spending plan.  

Without a spending plan in place, it’s anyone’s guess as to what the budget for the next year will look like. A wild card this year will be what happens during the March primaries, where Berger has a strong challenger back home in longtime Rockingham County Sheriff Sam Page. Whether Berger prevails in the Republican primary on March 3 will likely shape the rest of the year’s activity in Raleigh.

Meanwhile, some big health care and health policy issues are unresolved. Among them are a final budget number for the state’s Medicaid program, whether North Carolina will move ahead with building a children’s hospital, whether there’ll be more money for child care and what role private equity will play in North Carolina’s health care system. 

— Rose Hoban

Will private equity firms gain a foothold in the NC dental industry?

Republican leaders in the state Senate have shown an increased interest in recent years for new laws that would allow private equity firms to own and operate dental practices in North Carolina.

However, the North Carolina Dental Society has actively lobbied against such changes, and so far the state House of Representatives has not jumped on board with the Senate’s efforts to tweak North Carolina’s dental practice business model.

As it stands now, state law generally prohibits anyone not licensed to practice dentistry in North Carolina from owning or controlling dental practices in the state. The law allows dentists to contract with management companies for business support if a licensed dentist maintains control of the clinical practice.

Advocates for maintaining the current dental practice business model contend that ensuring licensed dentists own clinical practices keeps patient care at the forefront instead of allowing financial interests to drive clinical decisions.

Nationwide, private equity companies have been gaining a larger foothold in the dental industry. They come into the market offering the advantage of access to capital for equipment, new technology and expansion opportunities while also streamlining non-clinical administrative operations.

The American Dental Association issued a report by the ADA Health Policy Institute on Aug. 6 showing that the number of dentists associated with private equity across the country nearly doubled from 2016 to 2021. During that six-year period, dentists affiliated with such organizations went from 6.6 percent to 12.8 percent.

NC Health News will be keeping an eye out for bills introduced or revisited in the General Assembly that propose changes to the makeup of the North Carolina Board of Dental Examiners and selection process for its members, as well as any recommended clarifications of the definition of partnerships regarding the practice of dentistry.

— Anne Blythe

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