Across North Carolina, adolescents experiencing mental health crises wait in emergency rooms for days or even weeks for a psychiatric bed to become available. Youth in Mecklenburg County are no exception to this statewide challenge since the county, among many others, lacks the infrastructure required to treat the growing number of young people in crisis.
Rising treatment costs and insurance gaps leave many families with few options.
According to Anthony Trotman, Director of the Katie Blessing Center, capacity shortages have reached an extreme point.
“Kids were sleeping in office buildings, and kids were sleeping in conference rooms and hospitals because there wasn’t enough bed space here,” said Trotman.
Debate over the One Big Beautiful Bill Act, which includes substantial proposed cuts to Medicaid, Medicare and Affordable Care Act programs, adds to the uncertainty.
“As it relates to the One Big Bill, there’s obviously lots of uncertainty right now because of the proposed Medicaid cuts,” Trotman explained.
The Center plans to open in August 2026, hoping to rectify a critical shortage of youth behavioral health centers in Charlotte.
Founded by Dr. Michael Estramonte, a chiropractor who created STAR Med during the COVID-19 pandemic, the Center grew out of community conversations and a clear need for expanded youth mental health resources.
Trotman said they are also in conversations with Charlotte’s two largest hospitals, Novant Health and Atrium Health, about potential partnerships.
Because major hospital systems remain over capacity, the Center will help absorb referrals. “We will be accepting referrals from Atrium and or Novant,” continued Trotman. “Because of their lack of capacity — they’re having to ship kids to other parts of the state.”
Federal Funding Cuts and Their Local Impact
The One Big Beautiful Bill Act, signed into law earlier this year, is projected to reduce federal Medicaid funding by $793–$860 billion over the next decade. These reductions, along with stricter eligibility rules, create additional systemic strains on North Carolina’s already stressed behavioral health system.
Trotman explained that while youth Medicaid categories may technically remain covered, there is uncertainty regarding reimbursement. “Because we’re a pediatric behavioral health hospital, the youth that were covered prior to that would still be covered, but the state would have to make certain decisions as far as what that coverage looks like as it relates to reimbursement,” he said.
He also raised concerns about provider sustainability, indicating that providers may simply choose not to accept Medicaid because of the rate negotiations they have to go through.
North Carolina faces a significant state-level shortfall.
For the current budget year, the Department of Health and Human Services requested $819 million to maintain Medicaid services but received only $619 million, forcing reductions in provider reimbursement. Because Medicaid reimbursement is tied to federal matching funds, cuts will cost providers an estimated $1.1 billion collectively.
These pressures worsen existing structural gaps.
“Forty-four percent of the kids that need access to the psychiatric residential facility are sent outside of the state, and that equates to roughly around $70 million annually,” said Trotman.
Vermont’s Model
Despite national and statewide challenges, Vermont provides a promising model.
Programs such as the Vermont Child Psychiatry Access Program (VTCPAP) offer same-day psychiatric consultations to primary care physicians, helping address crises before hospitalization is required. Within its first 16 months, VTCPAP completed nearly 600 patient-specific consultations.
Although Vermont faces similar challenges, including workforce shortages and rising levels of youth distress, its coordinated system demonstrates the impact of early support and community integration.
Here at home, North Carolina’s Healthcare Access and Stabilization Program (HASP) offers temporary financial relief by increasing Medicaid payments to hospitals so that rates more closely match commercial insurance.
In 2025–2026, HASP is expected to bring $6.5 billion to hospitals statewide. However, federal policy changes concerning provider taxes, HASP’s funding mechanism, could threaten the program’s long-term stability.
The Katie Blessing Center advocates for adolescents in crisis even as funding uncertainties persist. However, no single organization can shoulder the burden alone.
Without additional inpatient psychiatric beds, expanded behavioral health workforce pipelines, and stable Medicaid reimbursement, the state’s youth mental-health system will remain at risk.
Queens University News Service stories are prepared by students in the James L. Knight School of Communication with supervision and editing from faculty and staff. The James L. Knight School of Communication at Queens University of Charlotte provides the news service in support of local community news.