Orange Card program braces for surge as Medicaid cuts loom

Orange Card, Guilford County’s donor-backed safety net for uninsured adults, could be hit with a surge if Medicaid work requirements push about 10,180 local residents off coverage. That would put immediate pressure on a program built to help people already living close to the edge.

The Orange Card is run by the Guilford Community Care Network, a system developed in 2007 under Guilford Adult Health, Inc., a private-public partnership involving Cone Health, High Point Medical Center and Guilford County through the county Department of Public Health. GCCN says it helps uninsured adults in poverty get primary care, specialty care and dental care through volunteer doctors, pharmacies and other health agencies, while also helping with problems like food insecurity and transportation.

The program serves Guilford County residents ages 19 to 64 with incomes from 0% to 200% of the federal poverty level. The Orange Card expires every six months, and residents must submit a new application about a month before it runs out. Applications can be dropped off at DSS Greensboro, 1203 Maple St., or DSS High Point, 325 E. Russell Ave., or submitted by email, fax or mail. Bilingual staff are available.

The likely Medicaid losses matter because they would not only increase the number of uninsured residents, but also strain the rest of the county’s safety net. Guilford County’s Division of Public Health already provides adult services for uninsured and underinsured residents, including diabetes resources, maternity care, family planning, refugee health, communicable disease services, TB testing, immunizations and medication assistance. The county also offers non-emergency medical transportation for residents with a Medicaid pink or blue card who have no other way to get to appointments, a benefit that could become more important as coverage changes ripple beyond doctor visits.

The policy fight is moving through Raleigh. House Bill 491, introduced April 1, 2025, would authorize federally approved Medicaid work requirements and require reporting on implementation funding needs. North Carolina expanded Medicaid in December 2023, and by March 25, 2025, about 640,000 people had enrolled in expansion coverage. County budget materials show about 172,000 Guilford County residents were enrolled in Medicaid as of early May 2026, with roughly 200,000 projected to qualify under expansion. Supporters such as Rep. Donny Lambeth have cast the bill as a signal to Washington, while Arkansas’ 2018 work requirement ended after about 18,000 people lost insurance and a court shut it down. For Guilford County, the question is whether Orange Card and the rest of the local safety net can absorb the next wave before it arrives.