The State Health Plan (Plan) has requested a temporary restraining order in Wake County Superior Court today to halt Atrium Health’s unlawful pricing scheme, announced less than a week before Open Enrollment begins for the Plan’s 750,000 members. The Plan contends Atrium's “Affordability Program” not only violates state law but will also put the Plan on a path to bankruptcy.
State law assigns the Treasurer, and the Treasurer alone, the duty to set the Plan’s copays, deductibles and coinsurance amounts. Atrium has never been given this authority, yet it believes it can change these amounts simply by posting new ones on its website. That’s not how it works.
While Atrium’s “Affordability Program” could lower out-of-pocket costs for some members who receive care at Atrium facilities, it is not “affordable” for the Plan and, in turn, its members and North Carolina taxpayers. It is intended to destabilize the Preferred Provider Program and put the Plan on a path to bankruptcy. Atrium will continue to charge the Plan its current rates, which are now among the highest charged by major hospital systems. Every member, including those served by Atrium, will have to pay for these higher rates in the form of significantly increased premiums and decreased benefits. Every taxpayer in the state will have to bear the burden of Atrium’s proposal when additional funding is needed for the Plan at the expense of other public programs, pay raises and COLA’s.
The Plan has been fully transparent with our members, our partners and the public that it is barely staying above water financially. In fact, due to the even higher than anticipated health care cost increases over the last year, the Plan will have a hard time staying in the black through the remainder of 2026.
In an effort to fix the Plan’s dire financial situation, the Plan is moving to a Preferred Provider network tiering system. It will give our members significant savings and is projected to save the Plan hundreds of millions pushing it toward financial stabilization. The Preferred hospital systems, UNC Health and Novant, as well as our Access partner Duke Health and others, have all offered significant discounts to the Plan. While Atrium offered the Plan discounts, they were never equal to what the other systems offered. And their offer came weeks after contracts had already been signed.
The Plan was blindsided by this new proposal, and we expect many of our members were as well. The Plan does not want members to feel rushed to figure out what makes the most financial sense for them and their families. Therefore, The State Health Plan’s Open Enrollment period has been extended through Nov. 6, 2026. The extension gives members more time to review information about the recently announced program and understand what it could mean for their 2027 coverage and costs. Members can use this additional time to review their options and make or update their elections before the new deadline.
As a note for the Humana Medicare Advantage Plan members, Atrium Health’s program does not affect your coverage.