SB 567 adjusts Medicaid reimbursement rates for substance use disorder (SUD) treatment services in North Carolina. It increases daily rates for outpatient programs (e.g., $255.28 for level 2.1 care) and establishes new coverage for residential treatment levels (e.g., $350/day for level 3.1), with higher rates for medically monitored services like detox ($756.65/day). The bill appropriates $15 million annually from the state General Fund to cover these rate changes, matching $27.4 million in federal funds for the 2025-2027 biennium. These changes directly affect Medicaid-certified SUD treatment providers by increasing their reimbursement rates for specific service levels, effective July 1, 2025.
SB 466 ensures continuity of care for North Carolina Medicaid beneficiaries with behavioral health and intellectual disabilities (BH IDD) who use specialized "Tailored Plans." It allows these individuals to stay in the standard Medicaid fee-for-service program (Medicaid Direct) if their current healthcare providers aren't in their Tailored Plan's network, and to choose a Tailored Plan outside their geographic area if it offers better services or provider access. The bill also requires the state to submit CMS waiver amendments by July 2025 and report to lawmakers by August 2025 on promoting competition among managed care organizations to improve care quality. These changes directly affect BH IDD Medicaid participants and aim to reduce disruptions in their healthcare.
SB 464 creates a new team-based care coordination service for Medicaid recipients with substance use disorders, including screening, medication treatment, recovery support, and case management. It also changes Medicaid policy to suspend coverage during incarceration (rather than terminate it), aligning with federal law to maintain access to care upon release. The bill requires the state health department to develop this service, report costs and implementation plans by October 2025, and launch a statewide education campaign for providers. This directly affects Medicaid enrollees with substance use disorders and incarcerated individuals in North Carolina.
SB 522, the "Thrive at Midlife Act," requires all health insurance plans in North Carolina to cover specific healthcare services for women aged 40-65, including menopause care, bone density screenings, heart disease prevention, diabetes management, cancer screenings, mental health support, and telehealth. It also expands Medicaid coverage for these services and allocates $10 million annually (2025-2027) to fund grants for community health centers serving uninsured midlife women, prioritizing rural and underserved areas. The bill creates tax credits for individuals and businesses covering qualified midlife healthcare expenses like prescription medications, screenings, and mental health services. These provisions aim to improve access to preventive and specialized care for midlife women while requiring insurers to limit copays and deductibles for covered services to federal preventive care standards.
SB 536, the Birth Freedom Act, requires all health insurance plans in North Carolina to cover maternity care at home or birthing centers on the same terms as hospital births. It mandates that Medicaid beneficiaries also receive full coverage for these options starting July 2025, with providers reimbursed at 90% of standard hospital rates for similar care. The bill allocates $150,000 to expand access to birthing center care under the State Health Plan for public employees, including potential subsidies for beneficiaries. These changes directly affect health insurers, Medicaid, birthing centers, and individuals seeking non-hospital maternity options.
SB 699 would expand Medicaid coverage for personal care services to adults living in licensed adult care homes who earn more than the standard income limit for state assistance but stay below 180-200% of the federal poverty level. It specifically targets individuals who would otherwise qualify for state-funded care but exceed income thresholds, aiming to provide alternatives to nursing home placements. The bill requires North Carolina's health department to request federal approval from CMS within 90 days, ensuring new coverage is fully offset by cost savings and meets all legal requirements. Implementation would only occur if CMS approves the request and all goals in the bill are met.
SB 737 requires North Carolina to adjust Medicaid reimbursement rates for licensed ambulatory surgical centers (ASCs) to at least 95% of the Medicare Ambulatory Surgical Centers fee schedule each year. This directly affects ASCs that treat Medicaid patients by increasing their payments to better align with Medicare rates. The bill provides $6.9 million annually in state funds to match $12.6 million in federal funds for implementation, ensuring the rate adjustments are fully funded. The changes will take effect on July 1, 2025.
HB 551 aims to improve access to Clubhouse model programs for North Carolinians with severe mental illness by creating a statewide reimbursement system for these services. It requires the state mental health agency to develop a plan by 2026 that includes incentives for Clubhouses to gain accreditation, consistent funding rates across regions, and staff training. The bill allocates $2.5 million in recurring funds starting July 2026 to support accredited Clubhouses for current programs, expansion, accreditation costs, and staff training. It also mandates Medicaid coverage for services under this new reimbursement system, directly affecting individuals with severe mental illness and Clubhouse providers.
HB 619, the Health Care Security Act, repeals a law that would have ended Medicaid expansion coverage in North Carolina if federal funding dropped below 90%. This change directly affects the state's Medicaid expansion population, ensuring their coverage remains secure regardless of federal funding fluctuations. The bill removes a specific statutory trigger (G.S. 108A-54.3C) that previously threatened automatic discontinuation of benefits. It does not create new programs or alter eligibility but prevents coverage loss due to federal funding changes. The act becomes effective upon enactment.
HB 629 extends the deadline for North Carolina's Primary Care Payment Reform Task Force from May 1, 2024, to December 31, 2026. The task force studies primary care spending across Medicaid, the State Health Plan, and commercial insurance to evaluate system adequacy, define primary care services, and identify data collection methods. This extension allows the task force additional time to complete its analysis and submit reports to legislative committees, directly affecting state agencies like the Department of Health and Human Services responsible for implementing the study.
