HB 128 appropriates $2 million annually for fiscal years 2025-2026 and 2026-2027 to create a statewide prostate cancer screening program administered by North Carolina's Department of Health and Human Services. The program provides free or low-cost screenings and follow-up care to uninsured or underinsured men aged 50-70 (40-70 with family history of prostate cancer) who meet income requirements (below 250% of federal poverty level). Eligibility requires no Medicare Part B or Medicaid coverage and specific age/family history criteria as defined in the bill. The program begins July 1, 2025.
HB 242 adds freestanding psychiatric hospitals (licensed, Medicare-certified facilities primarily providing psychiatric care that are not state-owned) to North Carolina’s Medicaid Healthcare Access and Stabilization Program (HASP). This expands the existing program - which currently reimburses acute care hospitals - to include these psychiatric hospitals, providing them with increased Medicaid reimbursements. The funding will come from a new quarterly assessment levied on the psychiatric hospitals themselves, calculated as a percentage of their hospital costs. The bill does not change patient eligibility but alters how these specific hospitals receive Medicaid payments through the HASP program.
SB 282 aims to expand access to clubhouse model psychosocial rehabilitation programs for adults with severe mental illness in North Carolina who are Medicaid beneficiaries. It requires the Department of Health and Human Services to develop a statewide reimbursement plan by December 2025, including incentives for clubhouse accreditation, consistent payment rates across managed care organizations, and staff training. The bill also appropriates $2.5 million annually (2025-2027) from the General Fund to the North Carolina Clubhouse Coalition to support member clubhouses for program expansion, accreditation, or staff training. This directly affects Medicaid-funded clubhouses, managed care organizations, and the coalition itself. The plan must be reported to the legislature by December 2025, with implementation effective July 2025.
SB 330 requires North Carolina's Local Management Entities/Managed Care Organizations (LME/MCOs) serving Medicaid beneficiaries for mental, behavioral, and substance use services to submit quarterly reports starting October 2025. These reports must include data on emergency department waits over 24 hours, access to providers within 30 days, unused funds due to provider shortages, and network provider counts. The bill also sets new service standards: LME/MCOs must ensure fewer than two people per county are "boarded" in hospital ERs (staying over 24 hours after medical clearance) and that 85% of approved services begin within 45 days. Failure to meet these benchmarks for two consecutive quarters triggers corrective action by the state. This directly affects Medicaid beneficiaries accessing behavioral health services and the LME/MCOs managing those services.
HB 453 increases Medicaid reimbursement rates for two specific services in North Carolina. It raises the rate for personal care services (e.g., help with daily tasks) to $7.50 per 15-minute increment for beneficiaries in programs like State Plan Personal Care Services and Community Alternatives programs. It also increases private duty nursing rates to $16.25 per 15 minutes for both children under 21 and adults, using state funds to match federal support. The changes, effective July 1, 2025, will directly affect Medicaid beneficiaries receiving these services through approved programs.
SB 379, the Senior Care Assurance Act, expands healthcare access for North Carolina seniors (65+) by enhancing Medicaid coverage for preventive screenings and chronic care services. It creates two new programs: a $2.5 million annual grant program to fund free health screenings and geriatric care for low-income seniors (at or below the federal poverty level), prioritizing rural and underserved areas, and a $2 million annual program to help seniors purchase telehealth equipment and internet access, with priority for rural seniors. The bill also updates telehealth infrastructure funding to support rural healthcare providers in establishing telehealth services. These provisions directly benefit seniors facing financial or geographic barriers to care, focusing on preventive health and independent aging.
HB 473 protects patients' and healthcare providers' rights to access and provide assisted reproductive technology (ART), including in vitro fertilization (IVF), by prohibiting state interference. It defines ART broadly and explicitly states that fertilized eggs or embryos outside the uterus are not considered "human beings" under North Carolina law. The bill also appropriates $500,000 annually (starting July 2025) from the state General Fund to increase Medicaid maternal support services (the Baby Love Program), matching $913,000 in federal funds for the 2025-2027 biennium. This legislation directly affects patients seeking ART, healthcare providers offering these services, and Medicaid beneficiaries receiving maternal support.
SB 366 increases Medicaid payment rates for personal care services to $7.50 per 15-minute increment and private duty nursing to $16.25 per 15-minute increment. It directly affects healthcare providers who deliver these services to Medicaid beneficiaries through programs like personal care services and private duty nursing. The bill allocates $119.2 million annually in state funds (with matching federal funds) to cover the rate increases for the 2025-2027 fiscal biennium. The changes take effect July 1, 2025.
SB 383, titled "Right to IVF," protects patients' access to assisted reproductive technology (ART) like in vitro fertilization (IVF), gamete intrafallopian transfer, and zygote intrafallopian transfer. It prohibits North Carolina or its subdivisions from restricting or interfering with patients' access to ART or healthcare providers' ability to offer or perform these services. The bill also clarifies that fertilized eggs or embryos outside the uterus are not legally considered "human beings" under state law. Additionally, it allocates $500,000 annually from 2025-2027 to expand Medicaid maternal support services (the Baby Love Program), matching federal funds for this purpose. The bill directly affects patients seeking ART and healthcare providers offering these services in North Carolina.
SB 463 requires North Carolina Medicaid to cover doula services during pregnancy and the postpartum period, directly affecting Medicaid-enrolled pregnant and postpartum individuals and doulas seeking to provide these services under Medicaid. The bill mandates the state health department to develop coverage rules, including reimbursement rates and provider requirements focused on doula training in areas like childbirth education, lactation support, and cultural awareness. It appropriates $1 million annually from the state general fund (matching $1.8 million in federal funds) for Medicaid coverage changes and $550,000 annually for doula workforce support services. The coverage must be implemented upon federal CMS approval, with a report to lawmakers by March 1, 2026.
