NC House and Senate Pass Deal On Medicaid Rebate Funding
This week, the North Carolina House and Senate passed an agreement on Medicaid rebate funding through the end of the year. The legislation passed both chambers with near unanimous support and final passage is expected next wee.
“We cannot continue to throw dollars at a program without making changes to protect taxpayers and ensure the North Carolinians who truly need Medicaid can get care,” Sen. Benton Sawrey (R-Johnston), chair of the Senate Health Care Committee, said. “Republicans in the General Assembly are taking fraud, waste, and abuse at all levels seriously, and this deal provides us an avenue to keep the program running while examining the reasons for the exorbitant cost increases.”
The legislation, House Bill 696, invests $319 million to support the current-year rebase while aggressively rooting out Medicaid waste, fraud, and abuse.
Sen. Amy Galey (R-Alamance), chair of the Senate Health Committee, said, “It’s unrealistic to believe that we should just pour more money into a program without making sure it’s performing as well as it can. Putting these measures in place will help us create a more efficient, cost-effective Medicaid program that delivers better outcomes for patients.”
The new version of House Bill 696 includes $319 million to fund the state’s Medicaid program, and includes provisions to:
Implement federally required work requirements and six-month redeterminations for current Medicaid expansion beneficiaries and applicants
Limit the use of self-attestation as the sole evidence of eligibility for Medicaid or SNAP
Prevent illegal aliens from receiving benefits, ensuring taxpayer dollars are only helping eligible North Carolinians
Fund a performance audit of the North Carolina Medicaid program and the NCWorks Career Centers
Provide tools for managed care organizations to more effectively manage beneficiary care by addressing fraud, implementing utilization management, and improving the overall quality of care
Direct the DHHS to develop a plan to achieve further cost savings and efficiency measures in the Medicaid program
Strengthen protections for children with autism spectrum disorder receiving Applied Behavior Analysis (ABA) therapy on Medicaid
Require providers to ensure high-quality standards and appropriate services for youth in our state by adding guardrails on who can provide these services and how they are delivered. It also ensures each beneficiary has an individualized care plan that includes parental involvement.
House Speaker Destin Hall said, “Medicaid should serve the people who truly need it, and this bill makes sure that happens. After Gov. Stein and his administration let costs run wild, we’re tightening things up by adding common-sense guardrails that cut down on waste, fraud, and abuse in the program. North Carolina taxpayers deserve confidence that their money is being spent wisely, and patients deserve a system that prioritizes care for those who depend on it the most.”
Beyond the healthcare matters, the bill also contains critical funding, including:
$1 million nonrecurring to cover the remainder of the 2025-26 school year scholarship awards for students receiving the Children of Wartime Veterans Scholarship
$10 million recurring in fiscal year 2026-27 for the Children of Wartime Veterans Scholarship program
$80 million nonrecurring for the Department of Adult Correction
$2.5 million recurring and $1.2 million nonrecurring for the State Bureau of Investigation
$165,000 nonrecurring to maintain and operate the Business Court’s current case management software
$13.1 million recurring and $8.5 million nonrecurring for the Division of Motor Vehicles
Sen. Jim Burgin (R-Harnett), chair of the Senate Health Committee, said, “North Carolinians across the state who rely on Medicaid should rest assured that the General Assembly is committed to making sure the program prioritizes care for residents, not its bureaucracy. I’m encouraged by the Department’s willingness to work with the General Assembly to keep costs down.”
