Wake County, WakeMed and Atrium Health signed the final terms Oct. 20: a five-year cap on price increases, 8% charity care and $2 billion from Atrium.
Wake County, WakeMed and Atrium Health have signed the last of the terms the county demanded before WakeMed can join Atrium. The documents were signed Tuesday, Oct. 20.
They cap how fast WakeMed’s prices can rise for five years. They raise the share of revenue WakeMed must spend on care for people who cannot pay. And they keep the county’s right to take back the hospital land, including the lot under WakeMed Cary Hospital on Kildaire Farm Road.
The deal is not done yet. The county’s amendment takes effect only after federal and other regulatory approvals and the formal closing, the county said in its Oct. 20 announcement.
What was signed
WakeMed and Atrium Health signed a separate agreement Oct. 20 that settles the points the Wake County Board of Commissioners raised at its Sept. 21 meeting, the county said. The key terms:
- $2 billion from Atrium’s own money. Atrium must spend at least $2 billion on WakeMed’s plans over the 15 years after closing. The money can come from any Atrium affiliate, but not from WakeMed itself.
- A five-year price cap. For five years after closing, the rates WakeMed negotiates for patients who are not on Medicaid or Medicare (Part A or C) cannot rise by more than 1.5 times Medicare’s annual payment update for that service.
- Yearly proof. WakeMed must report its compliance with the cap to the county commissioners in each of those five years. Breaking the cap would be a material breach of Atrium’s obligations, the county said.
Board Chair Don Mial signed the county’s Second Amendment to the Transfer Agreement the same day.
“Through fruitful negotiations, we have firm commitments to limit reimbursement rates, increase indigent care from a minimum of 4.8% to a minimum of 8%, invest $150 million in a new Wake County Whole Health Program and ensure the $2 billion in investments in WakeMed comes solely from Atrium Health,” Mial said.
Why Cary’s hospital is in the contract
WakeMed Cary Hospital opened Dec. 16, 1991, as Western Wake Medical Center, with 80 beds, according to WakeMed’s own history of the hospital. It replaced the old Western Wake Hospital in Apex, about five miles southwest.
The signed amendment lists only two pieces of land as “Restricted Property”:
| Site | Acres |
|---|---|
| Wake Medical Center, New Bern Avenue, Raleigh | 28.492 |
| Western Wake Medical Center, the building lot of today’s Cary hospital | 3.324 |
Source: Exhibit C of the Second Amendment to the Transfer Agreement, signed Oct. 20, 2026.
On that land, the amendment says:
- WakeMed must run it as a community general hospital, open to the public without discrimination (Section 4).
- If WakeMed breaks the hospital or charity care rules, or dissolves without a nonprofit successor, and does not fix it within 90 days of the county’s notice, ownership goes back to Wake County (Section 7).
- WakeMed cannot sell or lease the land without the county’s written consent and 30 days’ notice. Ordinary leases for health care use are allowed (Section 7).
That right goes back to 1997. WakeMed opened as Wake Memorial Hospital in east Raleigh in 1961, built with bonds Wake County voters approved. The county transferred its interest in the hospital to a private nonprofit in 1997, and it was renamed WakeMed in 1998, the county said in its Sept. 25 meeting summary.
Care for patients who cannot pay
WakeMed must serve county residents without regard to their ability to pay. Under the new terms, its spending on care for patients who cannot pay must equal at least 8% of its total adjusted revenue each year, up from 4.8%. If it falls short in a year, it is not in default as long as it puts the difference into a reserve for future care of those patients (Section 5).
The amendment also bars WakeMed from these collection steps, in line with federal tax rules for nonprofit hospitals (Section 7):
- selling a patient’s debt to another company, where federal rules forbid it
- reporting a patient to credit bureaus
- delaying or refusing needed care because of unpaid bills covered by its financial assistance policy
- suing patients, seizing bank accounts, garnishing wages or, where federal rules forbid it, placing liens on property
$150 million for county health programs
Atrium will pay Wake County $15 million a year for 10 years, $150 million in all, to fund a new Wake County Whole Health Program. The first payment is due at closing or on the first business day after Jan. 1, 2027, whichever is later. The last is due by Jan. 15, 2036 (Section 1).
The county said it will use the money to improve access to care and make it more affordable, expand mental health care, and help with affordable housing, food security and homelessness. Commissioners still have to approve each use through the county budget.
Who runs WakeMed after closing
WakeMed would become a nonprofit with Atrium Health as its sole member. Atrium is part of Advocate Health, a multistate health system. The 14-member WakeMed board would have:
- eight members appointed by the Wake County commissioners, who must live in Wake County
- six members appointed by Atrium
The commissioner appointees get oversight and enforcement powers to make sure Atrium keeps its promises, the county said in its Sept. 25 meeting summary. The vote itself is in the county’s Sept. 21 release.
How the county got here
- May 4: WakeMed asked commissioners to change its governance so it could combine with Atrium.
- June 8: WakeMed and Atrium staff presented the plan to the board.
- Aug. 17: The board held a public hearing and heard 89 comments.
- Sept. 21: Commissioners voted 5-2 to approve the amended articles of incorporation and transfer agreement. By then they had received more than 3,000 emails and heard 210 public comments, the county said.
- Oct. 20: The final negotiated points were signed.
If the deal never closes, the amendment is void and the 1997 agreement stays in force, the signed document says.
What it means for you
- Nothing changes at the Cary hospital today. WakeMed Cary Hospital, 1900 Kildaire Farm Road, is open 24 hours. The main number is 919-350-8000, according to WakeMed.
- The price cap starts only at closing. It limits the rates WakeMed negotiates, not any one bill, and it lasts five years.
- If you cannot pay a WakeMed bill, ask for its financial assistance policy. The new collection limits apply once the amendment takes effect.
- The $150 million is the county’s to spend. Decisions on the Whole Health Program will go through the Board of Commissioners and the county budget, starting in 2027 at the earliest.
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