Additional Medicaid Funds and Requirements.
SB 403 (North Carolina) prepares the state for potential federal approval of Medicaid work requirements. It requires the Department of Health and Human Services (DHB) to negotiate with the Centers for Medicare and Medicaid Services (CMS) if work requirements become authorized, and to notify specific legislative committees within 30 days of starting talks. After CMS approves a plan, DHB must submit a detailed report to those committees, including implementation dates and funding needs. The bill does not create new requirements but establishes a process for the state to implement them if federally approved. This is a procedural measure affecting Medicaid administration, not the current benefit structure.
Bill status
failed
3 of 5 stages cleared
Introduction
Mar 2025
Committee Review
Sep 2025
Senate Failed
Jul 2026
House Passage
Sep 2025
Governor
Introduced Mar 24, 2025
Last action Aug 6, 2026
Maddy AI version diff · 2 comparisons
What changed between versions
Edition 1
→
Edition 2
·
5 edits
MODERATE
The bill was completely rewritten from a proposal to implement Medicaid work requirements to a budget adjustment bill focused on cutting state agency positions and reducing Medicaid spending. The new version eliminates vacant state jobs, mandates specific cuts within the Department of Health and Human Services, and removes Medicaid coverage for obesity management medications. It also adjusts funding amounts to account for projected healthcare changes and requires managed care organizations to make intergovernmental transfers to the state.
Scope change
The bill's scope shifted entirely from adding new eligibility conditions for Medicaid recipients (work requirements) to modifying state budget allocations and reducing Medicaid program costs.
REQUIREMENT
All text regarding the implementation of Medicaid work requirements as a condition of participation was removed.
New requirements mandate the elimination of vacant positions across state agencies and specifically within the Department of Health and Human Services.
FISCAL
New provisions require managed care organizations to make intergovernmental transfers totaling approximately $18 million per fiscal year to the state.
Medicaid funding amounts were rewritten to adjust for projected enrollment and cost changes, with specific appropriations for managed care administration.
ELIGIBILITY
New provisions discontinue Medicaid coverage for obesity management medications while preserving coverage for diabetes medications.
Floor votes · Senate Jul 29, 2026 · House Sep 23, 2025
How they voted
0–36
Failed · 14 other
Total votes 50
Jul 29, 2026
D
Democratic19
52% Nay
R
Republican31
83% Nay
Vote distribution
All Yea
All Nay
Mixed
No data
Full legislative history
Actions timeline
Total actions
27
Key actions
5
Committee
8
Jul 29, 2026
Vote failed
Senate Vote: fail (0-36-14)
senate
Sep 25, 2025
Committee
Ref To Com On Rules and Operations of the Senate
upper
Sep 23, 2025
Lower · Passed
Passed 3rd Reading
lower
Sep 23, 2025
Lower · Passed
Reptd Fav Com Substitute
lower
May 5, 2025
Committee
Ref To Com On Rules, Calendar, and Operations of the House
lower
Apr 30, 2025
Upper · Passed
Passed 3rd Reading
upper
Apr 29, 2025
Upper · Passed
Reptd Fav
upper
Apr 10, 2025
Committee
Re-ref Com On Rules and Operations of the Senate
upper
Apr 10, 2025
Upper · Passed
Reptd Fav
upper
Mar 25, 2025
Committee
Re-ref to Health Care. If fav, re-ref to Rules and Operations of the Senate
upper
Mar 25, 2025
Committee
Ref To Com On Rules and Operations of the Senate
upper
Mar 24, 2025
Introduced
Filed
upper
0 primary · 6 co-sponsors
Sponsors
No sponsor information available.
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