HB 714 creates a state-run universal healthcare benefit plan administered by North Carolina's Commissioner of Insurance. It requires the plan to offer sliding-scale premiums based on household income, covering residents whose incomes exceed Medicaid eligibility but who cannot afford private insurance. The bill mandates the Commissioner to develop the plan by January 1, 2026, with a report to the legislature detailing implementation steps. It also appropriates $100,000 for initial planning in the 2025-2026 fiscal year and ensures coverage meets or exceeds federal Affordable Care Act standards.
HB 558 updates how North Carolina selects Medicaid health plans by limiting statewide contracts to four and allowing up to 12 regional contracts through local health providers. It requires the state to prioritize bids from local providers and those with high provider satisfaction scores from existing contracts. The bill also mandates staggered contract terms (3-5 years) to prevent coverage gaps during transitions. These changes directly affect Medicaid health plan contractors and the Division of Health Benefits, aiming to stabilize coverage and improve provider relationships.
SB 316 requires North Carolina hospitals and ambulatory surgical facilities to publicly disclose detailed pricing information for common medical services, including full charges, negotiated rates, and reimbursements from Medicaid, Medicare, and major insurers. Beginning in 2015, these facilities must submit quarterly reports to the state health department on the 100 most frequent inpatient diagnoses (DRGs) and common surgical/imaging procedures. The data will be made publicly available online, enabling patients and employers to compare costs and make informed healthcare decisions. This bill directly affects healthcare providers by mandating transparency but does not alter insurance coverage or set price limits. Its key mechanism is standardized reporting of pricing data to foster competition and affordability in the healthcare market.
SB 246 increases North Carolina's Medicaid Innovations Waiver slots by 5,000 for the 2025-2026 fiscal year and another 5,000 for 2026-2027, directly serving approximately 19,000 people with intellectual or developmental disabilities (I/DD) currently on a waiting list. The bill allocates $134 million (2025-2026) and $357.34 million (2026-2027) in state funds to cover a state match for federal funds, enabling these slots to be distributed based on waitlist length. It requires that direct care workers receive at least $20 per hour and ensures unused slots are redistributed to providers meeting wage and service capacity standards. This policy aims to reduce the waiting list, support caregivers in returning to work, and stimulate local economies through new jobs and community-based services.
SB 369 aims to ensure that certain telehealth providers can enroll as Medicaid providers in North Carolina. The bill specifies that individual health care providers, licensed by the state and offering services exclusively through telemedicine, do not need a physical presence in the state to be eligible for Medicaid enrollment. Additionally, medical provider groups that exclusively offer telemedicine services will not be required to have an in-state service address to enroll as Medicaid provider groups. This measure directly affects telehealth providers and Medicaid recipients by clarifying requirements for remote healthcare services.
HB 485 requires North Carolina's Medicaid agency to request federal approval to extend Medicaid coverage for personal care services to adults living in licensed adult care homes who earn more than the current State-County Special Assistance income limit but stay below 180-200% of the federal poverty level. The bill specifically targets individuals who would qualify for lower-income Medicaid assistance if not for their higher earnings. Before implementing this coverage, the agency must submit a CMS request meeting three conditions: covering the specified income group, ensuring cost savings offset new expenses, and complying with legal requirements. This bill does not immediately change coverage - it only authorizes a federal request, pending CMS approval.
SB 445 automatically adopts federal temporary waivers or modifications issued by the U.S. Department of Health and Human Services or Centers for Medicare & Medicaid Services under specific Social Security Act sections (1135 or 1812(f)) for North Carolina hospitals during declared emergencies. This means hospitals in disaster zones no longer need separate state approval to implement federal rule changes, directly affecting hospitals operating under such declarations. Key provisions include automatically waiving state hospital regulations to align with federal waivers and allowing temporary increases in bed capacity without additional state review. The bill streamlines emergency hospital operations by eliminating bureaucratic delays in applying federally authorized relief measures.
HB 696, the Health Care Practitioner Transparency Act, requires health care providers in North Carolina to clearly state their license type, certification, or registration in all advertisements and public representations. It prohibits deceptive claims about qualifications and bans unlicensed individuals from using medical titles like "doctor," "surgeon," or specialty terms (e.g., "cardiologist") to mislead patients. The law applies to licensed professionals (doctors, nurses, dentists, etc.) who advertise services, but exempts those in non-patient settings without direct care interactions. Violations could lead to disciplinary action by their licensing board, with daily noncompliance treated as separate offenses. The bill takes effect October 1, 2025.
SB 177 expands North Carolina's Medicaid Healthcare Access and Stabilization Program (HASP) to include qualifying freestanding psychiatric hospitals, allowing them to receive increased reimbursements for services. The bill creates a new assessment (a fee) on these hospitals, calculated as a percentage of their hospital costs, to fund the program. To implement this, the state must seek federal approval from CMS to include psychiatric hospitals in HASP. This change directly affects all Medicare-certified, state-licensed freestanding psychiatric hospitals in North Carolina, requiring them to pay the new assessment while gaining eligibility for enhanced Medicaid payments.
HB 576 makes technical revisions to North Carolina's laws governing the Department of Health and Human Services (DHHS). It designates DHHS as the agency managing school nurse funds, requiring school nurses to focus solely on health services (like health education and emergency response) rather than instructional duties. The bill extends until June 2028 the temporary use of the federal health insurance marketplace for determining Medicaid eligibility, and clarifies that Medicaid coverage for people released from prison continues for up to 12 months post-release. It also updates Medicaid provider screening rules to align with federal standards, particularly for Indian Health Program providers.
