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When the sprawling federal tax and spending law known as the Big Beautiful Bill was signed into law in July, a countdown began. That’s because the bill included major changes and cuts to Medicaid funding that are set to go into effect in just a little over a year. Now, dozens of state legislatures across the country are trying to navigate the early political and health policy fallout. And in North Carolina, all eyes are on one vulnerable group: rural healthcare providers.

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