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North Carolina ranks 8th in the nation in deaths among adults with an HIV diagnosis. The State of North Carolina has not yet expanded Medicaid under the Affordable Care Act. As a result, an estimated 4,100 of the lowest-income HIV+ residents of North Carolina have been left out of coverage available in other states. They must rely on Ryan White funding for crucial medical care and other supportive services. In 2011, an estimated 14,731 North Carolinians received services through the Ryan White program.