North Carolina HB 1138: Aging With Dignity Act.

Bill Text

GENERAL ASSEMBLY OF NORTH CAROLINA
SESSION 2025
H 1
HOUSE BILL 1138

Short Title: Aging With Dignity Act. (Public)
Sponsors: Representatives Ball, G. Pierce, G. Brown, and Pittman (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
*H1138-v-1*
A BILL TO BE ENTITLED 1
AN ACT PROMOTING AGING WITH DIGNITY BY STRENGTHENING HOME- AND 2
COMMUNITY-BASED CARE; IMPROVING LONG-TERM CARE OVERSIGHT; 3
SUPPORTING FAMILY CAREGIVERS AND THE GERIATRIC WORKFORCE; 4
APPROPRIATING FUNDS FOR STRATEGIC STATE INVESTMENTS TO MEET THE 5
NEEDS OF NORTH CAROLINA'S GROWING SENIOR POPULATION; AND 6
REESTABLISHING A STUDY COMMISSION ON AGING. 7
The General Assembly of North Carolina enacts: 8
9
PART I. LEGISLATIVE FINDINGS 10
SECTION 1.1. The General Assembly finds all of the following: 11
(1) North Carolina's population aged 65 and older is growing rapidly and is 12
projected to exceed 2.4 million residents by 2030, significantly increasing 13
demand for long-term services and supports. 14
(2) Older adults overwhelmingly prefer to remain in their homes and communities 15
when appropriate, yet access to home- and community-based services is 16
limited by workforce shortages, long waitlists, geographic disparities, and 17
administrative barriers. 18
(3) Institutional long-term care is costly to individuals, families, and the State, 19
while preventable hospitalizations, falls, medication-related injuries, and 20
delayed discharges contribute to unnecessary Medicaid expenditures and 21
strain the health care system. 22
(4) North Carolina relies on a direct care workforce that experiences low wages, 23
high turnover, limited career advancement opportunities, and growing 24
shortages that threaten access to safe and timely care for older adults. 25
(5) Family caregivers provide substantial unpaid care that reduces reliance on 26
institutional care and public expenditures, yet frequently lack adequate 27
financial support, respite services, and care coordination resources. 28
(6) The State has a responsibility to ensure that long-term care facilities operate 29
with transparency, accountability, and a focus on resident dignity, safety, and 30
quality of life and that regulatory and advocacy programs are adequately 31
staffed and empowered to protect residents. 32
(7) Demographic trends, workforce constraints, and rising costs make 33
continuation of current long-term care policies unsustainable without targeted 34
reforms and strategic investments. 35

General Assembly Of North Carolina Session 2025
Page 2 House Bill 1138-First Edition
(8) A coordinated policy framework that prioritizes aging in place when 1
appropriate, strengthens oversight of long-term care settings, supports 2
caregivers and the geriatric workforce, and invests in high-value, 3
person-centered care is necessary to protect older North Carolinians and 4
ensure responsible stewardship of public resources. 5
6
PART II. IMPROVEMENT OF LONG-TERM SERVICES & SUPPORTS FOR 7
MEDICAID BENEFICIARIES 8
9
HOME- AND COMMUNITY-BASED SERVICES PRESUMPTION FOR MEDICAID 10
BENEFICIARIES 11
SECTION 2.1. Part 6 of Article 2 of Chapter 108A of the General Statutes is 12
amended by adding a new section to read: 13
"§ 108A-70.5A. Presumption in favor of home- and community-based services for 14
long-term services and supports. 15
(a) Policy of the State. – It is the policy of the State that individuals aged 55 or older who 16
require long-term services and supports funded in whole or in part by the medical assistance 17
program should receive those services in the most integrated setting appropriate to their needs, 18
consistent with federal law. 19
(b) Presumption Established. – Except as provided in subsection (e) of this section, for 20
purposes of Medicaid-funded long-term services and supports, home- and community-based 21
services shall be presumed to be the preferred setting of care unless institutional placement is 22
determined to be medically necessary. 23
(c) Medical Necessity Determination. – An individual aged 55 or older may be placed in, 24
or remain in, an institutional long-term care setting, including a nursing facility or a 25
Medicaid-funded adult care home, only upon a documented determination that home- and 26
community-based services are insufficient to meet the individual's assessed clinical, functional, 27
or safety needs. 28
(d) Assessment and Documentation. – The determination required under subsection (c) 29
of this section shall include all of the following: 30
(1) A standardized assessment approved by the Department. 31
(2) Written clinical justification supporting the need for institutional placement. 32
(3) A periodic reassessment at intervals established by the Department. 33
(e) Individual Choice. – Nothing in this section shall be construed to limit an individual's 34
right to choose an institutional settin