In rural areas across North Carolina, access to healthcare is shaped not only by geography but also by economics, immigration status, and the ability to navigate a complex and often inequitable system. Medicaid, the public health insurance program jointly funded by state and federal governments, is designed to provide health coverage to low-income individuals, including children, pregnant women, people with disabilities, and in some states low-income adults without children. While it plays a crucial role in mitigating healthcare disparities, its reach remains limited in many rural communities. Medicaid generally reimburses healthcare providers at lower rates than private insurance, which can discourage provider participation and create disparities in access and quality.
For residents without insurance, especially recent immigrants and those living in poverty, healthcare often becomes a matter of last resort rather than preventive care. Clinics like CommWell Health have emerged as critical lifelines in these regions. CommWell Health is a Federally Qualified Health Center (FQHC) with a mission to deliver patient-centered, affordable, and culturally competent care to underserved communities. It offers a wide range of services from primary care and dental services to behavioral health and substance use treatment. Importantly, CommWell Health operates on a sliding-scale payment system based on income, meaning patients pay what they can afford, making care accessible even for the uninsured.
By examining the experiences of Maria Torres, Dr. George Gould, and Kesha Neely, we gain insight into the everyday challenges and triumphs of rural healthcare. Their stories illuminate both the promise and shortcomings of Medicaid, and the extraordinary efforts of community clinics to fill in the gaps.
Affordable Access and Cultural Competency
Maria Torres, a Certified Nurse Aide and interpreter at CommWell Health, provides first-hand insight into the lives of patients who rely on community health centers. Having grown up in Benson, North Carolina, she is deeply attuned to the needs of her rural, largely Hispanic community. Torres explains that many of the clinic’s patients are uninsured, often newly arrived immigrants unfamiliar with the U.S. healthcare system. “Most of the patients that come here, they’re uninsured or they’ve just moved in from a Latin American country”(Torres 9:25), she says, describing how the clinic’s sliding-scale payment plan ensures affordability. Based on federal poverty guidelines, this system adjusts fees according to household size and income, allowing patients to access care without incurring insurmountable debt.
Torres emphasizes that the clinic’s appeal goes beyond affordability. It also provides a culturally responsive environment with Spanish-speaking staff and interpreters. “They know we have interpreters”(Torres 9:22), she says, which helps patients feel seen and understood. In a state where language barriers can hinder access to basic care, these services build trust and encourage timely treatment. National statistics echo this reality: Hispanic individuals are nearly three times more likely to be uninsured than white Americans (Hill, Latoya, et al). For these populations, clinics like CommWell offer more than care, they offer belonging.
Systemic Inequities and Physician Perspectives
Dr. George Gould, a retired physician now working part-time at CommWell Health, offers a broader view on rural healthcare access. Having spent years in private practice in New York, he has witnessed stark differences in care based on insurance status. “The people with insurance definitely have easier access to good healthcare”(Gould 26:54), he says. “People who don’t have insurance don’t necessarily get to see the best people, and their healthcare can be delayed or absent”(Gould 26:57). His reflections expose a hard truth: the quality and timeliness of care in America are often dictated by insurance coverage.
Dr. Gould praises the origins of CommWell Health as a migrant clinic, noting how its mission continues to serve those most in need. The sliding-scale model helps eliminate the financial barriers that delay treatment. While North Carolina’s 2023 Medicaid expansion aimed to close coverage gaps, many people still fall through the cracks including undocumented immigrants and those unaware of their eligibility. For these groups, community clinics remain one of the only accessible options. Gould’s perspective underscores how community-based healthcare is often the frontline of care in rural America.
Hard Choices and Human Cost
Kesha Neely, who also works at CommWell Health, shares another dimension of rural healthcare challenges: the emotional and financial strain on patients managing chronic conditions. Speaking about HIV-positive clients, she describes the secrecy, stigma, and cost-related anxiety they face. “Do I take my medication or do I eat or do I pay my electric bill”(Neely 57:20), she asks, voicing the daily dilemmas of many rural residents. These choices are especially harrowing for those who are underinsured or entirely uninsured.
While Medicaid is designed to alleviate such burdens, many patients remain outside its reach. Barriers like complex enrollment processes, lack of documentation, or fear of stigma can keep individuals from applying. Even when coverage is obtained, not all providers accept Medicaid, and some medications may not be fully covered. Neely’s account reveals the ongoing struggle to balance medical needs with financial survival in rural settings.
The Limitations of Medicaid and the Risk of Avoidance
Even for those who do qualify for Medicaid, the experience of care can be disheartening. In some cases, patients report feeling stigmatized or dismissed by providers who view Medicaid reimbursement as less desirable. Long wait times, limited provider networks, and perceived second-class treatment can discourage patients from seeking care altogether. Studies have shown that Medicaid recipients are more likely to experience appointment delays and may struggle to find specialists willing to accept their insurance. One study was done showing that Medicaid patients were 20 percent more likely than privately insured patients to wait twenty minutes or longer (Finkelstein, Amy, et al). This creates a paradox where insurance exists, but meaningful access does not.
In rural areas, where provider shortages are already common, this dynamic is intensified. Patients may travel long distances only to be turned away or rushed through appointments. These experiences erode trust in the healthcare system and may lead people to postpone care until emergencies arise, further exacerbating health disparities. Clinics like CommWell Health combat this trend by offering a more compassionate, inclusive model, but they are often underfunded and overburdened.
Care Beyond the System
What emerges from these stories is a portrait of resilience and community-driven care. Through the voices of Torres, Gould, and Neely, we see not only the challenges of rural healthcare but also the solutions that come from within the communities themselves. Medicaid expansion has undeniably improved coverage in North Carolina, but gaps remain, particularly for immigrants, uninsured individuals, and those living in poverty.
Community health centers like CommWell Health offer a compelling alternative where care is affordable, culturally competent, and emotionally supportive. They succeed where the traditional system falters, not because of their resources, but because of their values. As the state continues to navigate the future of healthcare policy, these clinics and the people who power them should be at the center of the conversation. Their stories remind us that access to care is not just about having insurance, it’s about being treated with dignity, respect, and compassion.
Works Cited
Neely, Kesha. Interview with Madelaine Katz, 10 July 2019 (Y-0117). Southern
Oral History Program Collection (#4007). Southern Historical Collection, Wilson Library, University of North Carolina at Chapel Hill.
Gould, George. Interview with Joanna Ramirez, 26 June 2018 (Y-0026). Southern
Oral History Program Collection (#4007). Southern Historical Collection, Wilson Library, University of North Carolina at Chapel Hill.
Torres, Maria. Interview with Joanna Ramirez, 25 June 2018 (Y-0056). Southern
Oral History Program Collection (#4007). Southern Historical Collection, Wilson Library, University of North Carolina at Chapel Hill.
North Carolina Department of Health and Human Services. NC Medicaid. 2024, https://medicaid.ncdhhs.gov. Accessed 22 Apr. 2025.
Finkelstein, Amy, et al. “Outpatient Office Wait Times And Quality Of Care For Medicaid Patients.” MIT Economics , May 2017, www.healthaffairs.org/doi/full/10.1377/hlthaff.4.1.3. Accessed 25 Apr. 2025.
Hill, Latoya, et al. Health Coverage by Race and Ethnicity, 2010–2023. KFF, 13 Feb. 2025, https://www.kff.org/racial-equity-and-health-policy/issue-brief/health-coverage-by-race-and-ethnicity/.