Healthcare (Medicaid)

HB 491 prepares North Carolina's Medicaid program to implement work requirements if authorized by the federal Centers for Medicare and Medicaid Services (CMS). It requires the state's Division of Health Benefits to negotiate with CMS, notify oversight committees within 30 days of starting talks, and submit detailed reports after CMS approves any work requirements plan. The bill does not enact work requirements itself but establishes procedures for future implementation, including timelines for reporting funding needs. This would directly affect current Medicaid recipients if CMS approves work requirements, though the bill is procedural and conditional on federal approval. The legislation is currently in committee review and has not yet become law.

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.

HB 653 lowers the federal funding threshold that would trigger loss of Medicaid coverage for North Carolina's newly eligible expansion recipients. Currently, coverage would end if federal funding for this group drops below 90% compared to non-expansion recipients; the bill reduces this threshold to a lower percentage. If funding falls below the new threshold, Medicaid coverage for this group must discontinue promptly, with state agencies required to notify lawmakers and CMS. The bill affects only those added to Medicaid through the 2014 expansion, not all Medicaid beneficiaries.