State Health Plan Advocacy

State Health Plan Limits Member Access to WakeMed in 2027

On Wednesday, July 15, WakeMed learned along with the rest of the community that effective January 1, 2027, our health system will be considered a non-preferred provider for employees and retirees covered by the State Health Plan (SHP). 

This means the SHP will potentially charge state employees, retirees and their families substantially more for most WakeMed services. This news is damaging to WakeMed, our patients and the community, and it is SHP patients and families we serve who will be impacted the most. Their trusted relationships and care with our providers are at risk while creating both cost and access barriers for patients now having to travel outside of Wake County for many services that neither UNC Rex nor Duke Raleigh offer.

WakeMed has not been given the opportunity to negotiate our continued service to SHP members as an access-level provider. We remain proactive in our efforts to engage SHP leadership to better understand the evaluation process and any remaining opportunities for consideration as it is certainly in the best interest of SHP members.

How You Can Help WakeMed & SHP Members

We ask you, the members of the communities WakeMed serves to share your thoughts and support with the State Health Plan Board of Trustees. We welcome you to copy and paste the letter of support below into an email and send it to SHPBoard@nctreasurer.gov.

State Health Plan Board of Trustees,

As an area resident, I respectfully ask that you reconsider your decision and include WakeMed as an access-level provider in the State Health Plan.

The recent changes to the State Health Plan hurt the thousands of teachers and other staff members who support our schools and children, state employees, retirees and their families who have relied on WakeMed for many years. WakeMed is a cherished member of the community – providing ready access to care and caring for all.

State employees and retirees work hard for us and do not deserve limited access to this community asset. Nor do they deserve to be pressured into finding new providers or traveling to new facilities due to cost.

I urge the North Carolina State Treasurer and State Health Plan officials to reopen negotiations with WakeMed. It’s the right thing to do for our community.

Thank you for your consideration.

Detail on Plan Changes

Under the proposed plan changes, which take effect January 1, 2027, patients covered by the SHP will continue to have access to WakeMed's Emergency Departments and Trauma services. In addition, SHP members who are already receiving maternity, neonatal intensive care (NICU), oncology/cancer, or transplant services at WakeMed may qualify for the SHP’s Transition of Care provisions, allowing eligible services to continue to be covered for the duration of the approved Transition of Care period. WakeMed Primary Care providers will also remain in the SHP’s Preferred tier.

If You Need Emergency Care

Please be aware that all patients, regardless of their insurance status, may still seek treatment at any of WakeMed’s eight Emergency Departments, including the county’s only Children’s Emergency Department.

Under the No Surprises Act, emergency services must be covered by the patient’s insurer without prior authorization, regardless of whether the facility/provider is in-network or out-of-network, and without regard to any other term or condition of the patient’s insurance plan or coverage.

This means that patients will pay the same amount for emergency care and post-stabilization services (including inpatient admission from the Emergency Department, if needed) as they would if WakeMed were in-network with their insurance plan. Patients do not need to transfer to an in-network facility once the emergency medical condition is stabilized to benefit from the financial protections of the No Surprises Act.