North Carolina HB 546: Medicaid Modernization.

Bill Text

GENERAL ASSEMBLY OF NORTH CAROLINA
SESSION 2025

SESSION LAW 2025-64
HOUSE BILL 546

*H546-v-6*
AN ACT TO MODERNIZE VARIOUS LAWS PERTAINING TO THE MEDICAID
PROGRAM.

The General Assembly of North Carolina enacts:

PART I. JUSTICE-RELATED MEDICAID CHANGES
SECTION 1.1.(a) The Department of Health and Human Services, Division of
Health Benefits (DHB), is directed, in coordination with a working group of stakeholders
established by DHB, to develop a team-based care coordination Medicaid service that includes,
at a minimum, screening for alcohol use disorder, opioid use disorder, and other mild to moderate
substance use disorders; prescription medications for opioid use disorder and alcohol use
disorder; recovery support; and case management.
SECTION 1.1.(b) No later than October 1, 2025, the Department of Health and
Human Services, Division of Health Benefits, shall submit a report to the Joint Legislative
Oversight Committee on Medicaid and the Fiscal Research Division containing details on the
new Medicaid service developed in accordance with this section. The report shall include all of
the following:
(1) The State share of the cost of the service.
(2) The intended start date for the coverage of the service.
(3) The types of PHP capitated contracts that will cover the service and any
related proposed statutory changes to Article 4 of Chapter 108D of the General
Statutes.
SECTION 1.1.(c) The Department of Health and Human Services, Division of
Health Benefits, is directed to develop a statewide campaign to (i) educate health care providers
and community leaders about any changes made to the Medicaid program related to the treatment
of alcohol use disorder, opioid use disorder, and other mild to moderate substance use disorders,
(ii) train interested providers in clinical care for alcohol use disorder, opioid use disorder, and
other mild to moderate substance use disorders, and (iii) encourage substance use disorder
provider participation in the Medicaid program.
SECTION 1.2. The Department of Health and Human Services (DHHS), Division
of Health Benefits, shall continue to implement its policy changes to suspend, rather than
terminate, Medicaid benefits upon a Medicaid beneficiary's incarceration, as required by the
federal Consolidated Appropriations Act, 2024, P.L. 118-42. No later than October 1, 2025,
DHHS shall submit to the Joint Legislative Oversight Committee on Medicaid and the Fiscal
Research Division a report on (i) DHHS's progress implementing the automated process in the
NCFAST eligibility information system that allows data sharing between county jails and DHHS
and (ii) any ongoing challenges to meeting the federal requirement to suspend, rather than
terminate, Medicaid benefits upon a Medicaid beneficiary's incarceration.
SECTION 1.3. Except as otherwise provided, this Part is effective when this act
becomes law.

Page 2 Session Law 2025-64 House Bill 546
PART II. EXPEDIENT IMPLEMENTATION OF MEDICAID WORK
REQUIREMENTS
SECTION 2.1.(a) Section 2.4 of S.L. 2023-7 reads as rewritten:
"SECTION 2.4. If there is any indication that work requirements as a condition of
participation in the Medicaid program may be authorized by the Centers for Medicare and
Medicaid Services (CMS), then the Department of Health and Human Services, Division of
Health Benefits (DHB), shall enter into negotiations with CMS to develop a plan for those work
requirements and to obtain approval of that plan. Within 30 days of entering into negotiations
with CMS pursuant to this section, DHB shall notify, in writing, the Joint Legislative Oversight
Committee on Medicaid (JLOC) and the Fiscal Research Division (FRD) of these negotiations.
Within 30 days of approval by CMS of a plan for work requirements as a condition of
participation in the Medicaid program, DHB shall submit a report to JLOC and FRD containing
the full details of the approved work requirements, including the approved date of
implementation of the requirements and any funding necessary to implement or maintain the
requirements. Notwithstanding any provision of G.S. 108A-54.3A to the contrary, the
Department of Health and Human Services shall implement any work requirements as a condition
of participation in the Medicaid program approved by the Centers for Medicare and Medicaid
Services in accordance with this section."
SECTION 2.1.(b) This section is effective when this act becomes law.

PART III. TELEHEALTH SERVICE PROVIDER ELIGIBILITY
SECTION 3.1.(a) The Department of Health and Human Services, Division of
Health Benefits, shall ensure that a health care provider duly licensed by the State that provides
health care services exclusively through telehealth services shall not be required to maintain a
physical presence in the State to be considered an eligible provider for enrollment as a Medicaid
provider.
SECTION 3.1.(b) The Department of Health and Human Services, Division of
Health Benefits, shall ensure that a health care provider group with health care provide