North Carolina HB 1147: Amend Spay/Neuter Program Eligibility.

Bill Text

GENERAL ASSEMBLY OF NORTH CAROLINA
SESSION 2025
H 1
HOUSE BILL 1147

Short Title: IDD Omnibus. (Public)
Sponsors: Representatives Hawkins, Crawford, Quick, and Almond (Primary Sponsors).
For a complete list of sponsors, refer to the North Carolina General Assembly web site.
Referred to: Appropriations, if favorable, Rules, Calendar, and Operations of the House
May 4, 2026
*H1147-v-1*
A BILL TO BE ENTITLED 1
AN ACT TO IMPLEMENT VARIOUS CHANGES RECOMMENDED BY THE 2
LEGISLATIVE JOINT CAUCUS FOR INTELLECTUAL AND DEVELOPMENTAL 3
DISABILITIES TO POSITIVELY IMPACT THE LIVES OF NORTH CAROLINA 4
CITIZENS WITH INTELLECTUAL OR OTHER DEVELOPMENTAL DISABILITIES. 5
The General Assembly of North Carolina enacts: 6
7
PART I. DIRECT CARE WORKER WAGE INCREASES 8
SECTION 1.(a) It is the intent of the General Assembly to assist in increasing the 9
hourly wages of direct care workers in this State to a minimum of eighteen dollars ($18.00) per 10
hour. To that end, the Department of Health and Human Services, Division of Health Benefits 11
(DHB), shall provide a Medicaid rate increase to all of the following: 12
(1) Home- and community-based providers enrolled in the Medicaid program. 13
(2) Intermediate care facilities for individuals with intellectual disabilities 14
(ICF/IIDs), including ICF/IID-level group homes. 15
(3) Providers who provide services to Medicaid beneficiaries receiving services 16
through the North Carolina Innovations waiver program, the Community 17
Alternatives Program for Children, or the Community Alternatives Program 18
for Disabled Adults, and who are either (i) enrolled in the Medicaid program 19
or (ii) approved financial managers or financial support agencies billing for 20
personal care service or waiver service hours provided by direct care workers 21
that are hired by employers of record or managing employers under 22
consumer-directed or self-directed options in accordance with any of the 23
following Medicaid Clinical Coverage Policies: 24
a. 8-P: North Carolina Innovations. 25
b. 3K-1: Community Alternatives Program for Children (CAP/C). 26
c. 3K-2: Community Alternatives Program for Disabled Adults 27
(CAP/DA). 28
d. 8H-1: 1915(i) Supported Employment. 29
e. 8H-4: 1915(i) Respite. 30
f. 8H-5: Community Living and Supports. 31
g. 8H-6: 1915(i) Community Transition. 32
SECTION 1.(b) DHB, working with a workgroup of providers, shall determine the 33
definition of direct care worker to be applied and the amount of the rate increases to be 34
implemented under this section. DHB shall further determine the manner in which a provider or 35

General Assembly Of North Carolina Session 2025
Page 2 House Bill 1147-First Edition
facility shall utilize the increased rate and demonstrate compliance with those utilization 1
requirements, including the documentation required to be kept by the provider or facility. This 2
documentation shall be made available upon request by DHB or by the relevant local 3
management entity/managed care organization (LME/MCO). 4
SECTION 1.(c) Any rate increase provided under this section shall be effective on 5
the date approved by the Centers for Medicare and Medicaid Services. Upon implementation of 6
an applicable rate increase required by this section, DHB shall adjust the per member per month 7
(PMPM) capitation amount paid to LME/MCOs and the entity operating the children and families 8
specialty plan accordingly. All LME/MCOs and the entity operating the children and families 9
specialty plan shall be required to implement the increase. 10
SECTION 1.(d) In addition to other allowable reasons for recoupment of funds, if 11
DHB or an LME/MCO determines any funds related to a rate increase required under this section 12
were not used to the benefit of direct care workers, then DHB or the LME/MCOs shall recoup 13
part or all of those funds. 14
SECTION 1.(e) There is appropriated from the General Fund to the Department of 15
Health and Human Services, Division of Health Benefits, the sum of one hundred eighty-three 16
million dollars ($183,000,000) in recurring funds and associated receipts beginning with the 17
2026-2027 fiscal year to implement this section. 18
SECTION 1.(f) This section is effective July 1, 2026. 19
20
PART II. FUND ADDITIONAL INNOVATIONS WAIVER SLOTS AND DEVELOP A 21
10-YEAR PLAN TO ADDRESS THE REGISTRY OF UNMET NEEDS 22
SECTION 2.(a) The Department of Health and Human Services, Division of Health 23
Benefits, shall amend the North Carolina Innovations waiver to increase the number of slots 24
available under the waiver by a minimum of 1,000 slots. These additional slots shall be made 25
available upon approval by the Centers for Medicare and Medicaid Services. 26
SECTION 2.(b) There is appropriated from the General Fund to the Department of 27
Health and Human Services, Division of Health Benefits, the sum of thirty-six million two 28
hundred thousand dollars ($36,200,000) in recurring funds and associated receipts beginning 29
with the 2026-2027 fisca