For many of the 750,000 teachers and state employees covered by North Carolina’s State Health Plan, the recent overhaul of the plan’s provider network has created a cloud of confusion during this year’s open enrollment period. The plan, which serves a large portion of the state’s public‑sector workforce, announced a new three‑tier system in an effort to curb a projected $58 million shortfall in 2027.
Tiered system explained
The State Health Plan now classifies hospitals and health systems as preferred, access or non‑preferred. Preferred providers carry the lowest copays, access providers keep copays steady, and non‑preferred providers require higher out‑of‑pocket costs. UNC Health, Novant Health and Iredell Health were placed in the preferred tier, while WakeMed and Duke Lifepoint fell into the non‑preferred tier. Most other hospitals, including Atrium Health, were assigned to the access tier.
To protect patients with serious conditions, the plan carved out exceptions: emergency‑room visits, behavioral‑health services, cancer treatment, maternity care, organ transplants and NICU stays will retain the same rates regardless of tier.
Impact on local teachers
Shanna Peele, a Buncombe County teacher, has driven two hours each way to Atrium Health’s rheumatology clinic in Charlotte for years. When Atrium was briefly labeled a non‑preferred provider in July, Peele feared higher costs and even considered switching doctors. After a lawsuit from State Treasurer Brad Briner and a week‑long removal of Atrium from the network, the two sides reached an agreement on Oct. 27 that restored Atrium to the access tier, keeping Peele’s copays unchanged for 2027.
“To be honest, I haven’t really been able to keep up with all the news,” Peele told the Carolina Public Press. She used the enrollment extension—from Oct. 30 to Nov. 6—to weigh her options, ultimately deciding that cost and continuity of care will guide her choice.
Joanna Loftis, a multilingual teacher in Charlotte‑Mecklenburg Schools, echoed the frustration. Her family receives care at Atrium, and the sudden tier changes left her uncertain. “It’s been very frustrating … the complete changing from one day to another, not knowing what’s going on,” she said. Loftis, who also serves as president of the North Carolina chapter of the American Federation of Teachers, helped draft a letter urging the State Health Plan and Atrium to provide clear, written guidance during enrollment. Neither organization responded.
Financial rationale
State Treasurer Brad Briner inherited a fiscal crisis after years of medical costs outpacing revenue. His office estimates the tiered system could save the plan “hundreds of millions of dollars,” though a $58 million deficit remains projected for 2027. To bridge the gap, trustees approved a draw from the Retiree Health Benefit Fund to keep the plan solvent through the end of the year.
WakeMed’s separate battle
While Atrium secured an access‑tier designation, WakeMed—another major health system in the Research Triangle—was left out of the upgrade. WakeMed is pursuing a merger with Atrium, pending regulatory approval, and argues it was not given a fair opportunity to negotiate an access‑level status. The system’s statement emphasized a desire to engage State Health Plan leadership to understand the evaluation process.
Alex Wall, an elementary‑school teacher in Raleigh, is already switching his cardiologist from WakeMed to UNC Health after learning his current provider was non‑preferred. He noted the difficulty many colleagues face in navigating the new tiers, saying, “There’s a cloud of confusion, and people don’t know how complicated this is until they try and do it.”
Open enrollment timeline
The State Health Plan’s open enrollment runs through Nov. 6. Loretta Boniti, a spokeswoman for the Treasurer’s Office, confirmed there will be no further extensions despite the ongoing provider negotiations. As of Oct. 30, 115,879 members had taken action on their plans, and the office reported no holdouts specifically due to Atrium’s or WakeMed’s tier status.
For teachers and state employees navigating the new system, the key takeaway is to verify whether their preferred doctors are listed as preferred, access or non‑preferred providers and to consider the impact on copays before the deadline.
Original reporting: Carolina Public Press — read the source article.
