Healthcare (Medicaid)

in committee · North Carolina · Senate Mar 26, 2025

SB 494: Limit the Scope of Certificate of Need Laws.

SB 494 limits North Carolina's Certificate of Need (CON) requirements, which typically require state approval for new healthcare facilities or expansions. The bill exempts all counties from CON rules except those with fewer than 100,000 residents *and* at least one functioning hospital. It creates a new "qualified urban ambulatory surgical facility" category, allowing certain surgical centers in larger counties to opt out of CON by meeting charity care reporting standards (ensuring at least 4% of revenue comes from self-pay or Medicaid patients). This directly affects healthcare providers planning new facilities or expansions in most counties, removing a major regulatory hurdle for projects exceeding $4 million in cost. The policy change takes effect November 2025, with specific reporting requirements for facilities choosing the opt-out path.

Topics ✓ HealthcareSupports HealthcareBill reduces regulatory barriers for healthcare facilities by limiting Certificate of Need requirements, allowing more competition and potentially improving patient access in eligible areas.90% confidence

Sub-Topics Hospitals Medicaid

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in committee · North Carolina · Senate Mar 26, 2025

SB 567: Medicaid SUD Services Rate Adjustment Act.

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.

Topics ✓ Budget & TaxesSupports Budget & TaxesAllocates $15M state General Fund to increase Medicaid SUD reimbursement rates, directly funding essential public health services per budget appropriations language.95% confidence ✓ Criminal JusticeSupports Criminal JusticeFunds SUD treatment, supporting rehabilitation programs linked to criminal justice reform80% confidence ✓ HealthcareSupports HealthcareIncreases Medicaid reimbursement rates for SUD treatment, adds new coverage levels, and appropriates $15M state funding to expand access to substance use disorder healthcare services.95% confidence

Sub-Topics State Budget Medicaid Substance Abuse

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in committee · North Carolina · Senate Mar 25, 2025

SB 466: Ensure Continuity of Care in Tailored Plans.

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.

Topics ✓ HealthcareSupports HealthcareEnsures Medicaid continuity for BH IDD beneficiaries by allowing provider choice and out-of-area Tailored Plans, improving access to care without restricting coverage.90% confidence

Sub-Topics Medicaid Mental Health

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in committee · North Carolina · Senate Mar 25, 2025

SB 464: Inmate Medicaid Suspension/Team-Based Care.

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.

Topics ✓ Criminal JusticeSupports Criminal JusticeBill maintains Medicaid access during incarceration (vs termination) and creates team-based substance use treatment for inmates, advancing rehabilitation-focused correctional healthcare reform to reduce recidivism.95% confidence ✓ HealthcareSupports HealthcareCreates team-based Medicaid care for substance use disorders, maintains coverage during incarceration to improve access, and requires implementation plans - directly expands healthcare services and continuity for vulnerable populations.95% confidence

Sub-Topics Corrections Medicaid Substance Abuse

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in committee · North Carolina · Senate Mar 26, 2025

SB 522: Thrive at Midlife Act.

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.

Topics ✓ Budget & TaxesSupports Budget & TaxesAllocates $10M annually (2025-2027) for community health center grants, directly funding public health services under budgetary provisions.95% confidence ✓ HealthcareSupports HealthcareMandates insurance coverage for women's health services, expands Medicaid, allocates $10M for community health centers, and explicitly includes mental health support and telehealth under healthcare services.95% confidence

Sub-Topics Insurance Medicaid Women's Health

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in committee · North Carolina · Senate Mar 26, 2025

SB 536: Birth Freedom Act.

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.

Topics ✓ HealthcareSupports HealthcareMandates insurance coverage for home/birthing center births, expands Medicaid maternity coverage, allocates $150k to increase access to birthing centers.95% confidence

Sub-Topics Insurance Medicaid Women's Health

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in committee · North Carolina · Senate Mar 26, 2025

SB 699: Adult Care Home Medicaid PCS Coverage.

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.

Topics ✓ HealthcareSupports HealthcareExpands Medicaid coverage for personal care services, targets vulnerable adults, provides alternatives to nursing homes - directly advances healthcare access and funding.95% confidence

Sub-Topics Long-Term Care Medicaid

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in committee · North Carolina · Senate Mar 26, 2025

SB 727: Number of Medicaid Standard Plan Contracts.

SB 727 adjusts North Carolina's Medicaid program by reducing the maximum number of regional contracts awarded to provider-led groups (PLEs) from up to 12 to up to 4 per contract cycle. It maintains four statewide contracts for commercial health plans to cover Medicaid recipients across the state. The bill requires the state to award contracts based on provider responses to requests for proposals, ensuring coverage continuity if fewer than four providers meet requirements. This directly affects Medicaid recipients, commercial health insurers, and provider-led groups managing regional or statewide coverage.

Topics ✗ HealthcareOpposes HealthcareReduces Medicaid provider contracts from 12 to 4 regional contracts, limiting provider options and potentially restricting access to care for Medicaid recipients.85% confidence

Sub-Topics Medicaid

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died · North Carolina · Senate Mar 26, 2025

SB 737: Medicaid Rates/Ambulatory Surgical Centers.

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.

Topics ✓ Budget & TaxesSupports Budget & TaxesBill allocates $6.9M state funds annually to adjust Medicaid rates for ASCs, fully funding rate increases through state-federal matching. Directly addresses budget appropriations for public health services.95% confidence ✓ HealthcareSupports HealthcareIncreases Medicaid reimbursement rates for ASCs to 95% of Medicare rates with full state/federal funding, strengthening provider payments and access to care.95% confidence

Sub-Topics Fees & Licensing Medicaid Medicare

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in committee · North Carolina · House Mar 31, 2025

HB 551: Clubhouse Expansion.

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.

Topics ✓ Budget & TaxesSupports Budget & TaxesAllocates $2.5M recurring funds for mental health Clubhouse programs, directly increasing state budget allocation for public health services under appropriations.95% confidence ✓ HealthcareSupports HealthcareAllocates $2.5M recurring funds for mental health Clubhouse programs, creates reimbursement system, and mandates funding plan to expand access to mental health services.95% confidence

Sub-Topics Medicaid Mental Health

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