HB 491 North Carolina House · 2025-2026 Session

Medicaid Rebase Funding.

HB 491 prepares North Carolina's Medicaid program to implement work requirements if authorized by the federal Centers for Medicare and Medicaid Services (CMS). It requires the state's Division of Health Benefits to negotiate with CMS, notify oversight committees within 30 days of starting talks, and submit detailed reports after CMS approves any work requirements plan. The bill does not enact work requirements itself but establishes procedures for future implementation, including timelines for reporting funding needs. This would directly affect current Medicaid recipients if CMS approves work requirements, though the bill is procedural and conditional on federal approval. The legislation is currently in committee review and has not yet become law.

Issues: ✗ Healthcare

Bill status failed 3 of 5 stages cleared

Introduction

Mar 2025

Committee Review

Oct 2025

House Passage

Oct 2025

Senate Passage

Governor

Introduced Mar 24, 2025 Last action Oct 23, 2025

Maddy AI version diff · 2 comparisons

What changed between versions

Edition 1 → Edition 2 · 5 edits

MODERATE

This bill was completely rewritten from a Medicaid work requirements proposal to a funding allocation measure. The original version sought to implement work requirements for Medicaid recipients, while the new version appropriates $190 million from the Medicaid Contingency Reserve and establishes intergovernmental transfers totaling $36 million between fiscal years 2025-2027 to local managed care organizations.

Scope change

The bill's scope shifted entirely from implementing work requirements for Medicaid participants to funding Medicaid program adjustments and managed care organization transfers.

REQUIREMENT

All provisions related to Medicaid work requirements, including negotiations with CMS, reporting requirements, and implementation timelines for work conditions, were completely removed.

Added authority for the Department of Health and Human Services to reallocate transfer amounts if counties realign with different managed care organizations during the fiscal biennium.

FISCAL

Added $190 million appropriation from the Medicaid Contingency Reserve to adjust Medicaid funding for enrollment changes, cost projections, and implementation of the Children and Families Specialty Plan.

Added mandatory intergovernmental transfers totaling $18,028,217 per year for fiscal years 2025-2026 and 2026-2027 to four specific local managed care organizations (Alliance Behavioral Healthcare, Partners Health Management, Trillium Health Resources, and Vaya Health).

TIMELINE

Changed effective date from immediate implementation of work requirements to retroactive effectiveness starting July 1, 2025, for the new funding provisions.

Floor votes · House Oct 22, 2025

How they voted

110–0

Passed · 9 other

Total votes 119

Oct 22, 2025

D Democratic46

45 Yea 1

97% Yea

I Independent2

2 Yea

100% Yea

R Republican71

63 Yea 8

88% Yea

Vote distribution

All Yea All Nay Mixed No data

Full legislative history

Actions timeline

Total actions

Key actions

Committee

Oct 22, 2025

Lower · Passed

Passed 3rd Reading

lower

Oct 21, 2025

Lower · Passed

Reptd Fav Com Substitute

lower

Apr 1, 2025

Committee

Re-ref Com On Rules, Calendar, and Operations of the House

lower

Apr 1, 2025

Lower · Passed

Reptd Fav

lower

Mar 25, 2025

Committee

Ref to the Com on Health, if favorable, Rules, Calendar, and Operations of the House

lower

Mar 24, 2025

Introduced

Filed

lower

3 primary · 19 co-sponsors