Members of several joint committees were back in Raleigh this week as interim committee meetings ramped back up. Lawmakers serving on the Joint Legislative Oversight Committee on Health and Human Services met Tuesday morning to hear an update from Department of Health and Human Services (DHHS) Secretary Kody Kinsley. The committee also heard from Deputy Secretary for Opportunity and Well-Being, DHHS, Susan Osborne on the state of child welfare throughout North Carolina. During the presentation, Deputy Secretary Osborne advocated for state aid to county Department of Social Services’ (DSS) to help counties address the current workforce challenges they face. Deputy Secretary Osborne stated that flexible funding would allow counties to address the specific challenges their local workforce is facing by funding things such as increased pay, hiring and retention bonuses, and creating new positions to help ease some of the workload burden felt by existing DSS staff.
Ariel Ford, Director of the Division of Child Development and Early Education, also presented to the committee Tuesday morning, focusing on the Division’s ask of the legislature to provide funding for child care as the state approaches a July 2024 funding cliff. The funding cliff comes after North Carolina made the decision to use one-time federal stabilization grant funding to subsidize child care during the pandemic, allowing more teachers and more centers to stay open. However, that one-time funding will soon run out unless the legislature acts during the upcoming short session.
Members reconvened Tuesday afternoon for the Joint Legislative Oversight Committee on Medicaid meeting. Adam Levinson, Chief Financial Officer, Division of Health Benefits, presented to the committee about the status of the state’s Medicaid budget. Levinson indicated that, right now, Medicaid is roughly on budget, however, there are still some unknowns that may impact the budget, such as the pace of the adult enrollment decline. Jay Ludlam, Deputy Secretary for NC Medicaid, presented to the committee as well, providing an update on the status of Medicaid transformation, specifically addressing the success of the recent, legislatively mandated consolidation of the state’s six local management entity/managed care organizations (LME/MCOs) to four, ensuring all of the plans are on track to launch the Tailored Plans on July 1, 2024.
Deputy Secretary Ludlam also highlighted some of the major successes of the Medicaid expansion rollout that took place at the end of last year, with 273,000 enrollees already enrolled in full Medicaid coverage on the official start date, December 1, 2023. As of the end of January, 2024, approximately 340,000 total enrollees were enrolled in full Medicaid coverage through the expansion program.
2023 Session Recap: Health Policy
The 2023 long session tackled several outstanding healthcare-related issues that have carried over from session to session. Over the course of last year’s long session, which ran from the end of January through November, lawmakers were able to accomplish their main priority – passing a biennial budget for the 2023-2025 fiscal years. The budget became law on October 3, 2023, without the Governor’s signature.
The Health and Human Services section of the FY 2023-2025 budget, HB 259: 2023 Appropriations Act, includes:
- $7.33 billion in FY 2023-24, a 12% increase, and $7.67 billion in FY 2024-25, a 4.7% increase.
- Retains the enhanced COVID-19 Medicaid reimbursement rates for skilled nursing facilities and personal care services.
- Provides funding to increase the reimbursement rates paid to Medicaid behavioral health providers.
- Increases funding for the state’s Innovations waiver program to add 350 slots and increase direct care workers wages who serve those participating in the Innovations waiver program.
- Increases the Medicaid reimbursement rates for private duty nursing services from $45 per hour to $52 per hour.
- Delays the implementation of behavioral health and intellectual/developmental disabilities tailored plans until no later than July 1, 2024, with an initial contract term of no less than 4 years.
- Directs DHHS to issue an initial RFP for a single statewide children and families specialty plan to serve children and families involved in the foster care system and begin by December 1 of this year.
- Requires the Secretary of DHHS to reduce the number of LME/MCOs from 6 to 4 and provides the Secretary the authority to direct the dissolution, merger, or consolidation of the existing LME/MCOs to achieve the required reduction.
- Establishes an Office of Child Fatality Prevention to serve as the lead agency for child fatality prevention in North Carolina.
- $25 million in nonrecurring funds both years of the biennium to expand the North Carolina Loan Repayment Program and create additional loan repayment initiatives for primary care physicians and other health providers who agree to practice in rural and underserved communities.
- $5 million in the first year of the biennium and $15 million in the second year of the biennium to establish a competitive grant program that provides grants to rural health care providers to purchase start-up equipment for telemedicine.
- $1 million in FY 2023-24 to the North Carolina Area Health Education Centers Program (NC AHEC) to develop five outpatient team-based clinical teaching sites in rural areas of the state and study impediments to the availability of community-based preceptors.
- $20 million in nonrecurring funds in the second year of the biennium for the implementation of electronic health records at state-operated healthcare facilities, in addition to $5 million in recurring funds, beginning in the second year of the biennium, for electronic health record operations and maintenance needs.
- $75 million over the course of the two year biennium to increase the child care subsidy reimbursement rates for providers.
- $11.3 million, resulting from the North Carolina settlement with Juul Labs, Inc., in nonrecurring funds each year of the biennium for activities to mitigate youth electronic cigarette and tobacco use in youth grades 4-12.
- $6 million in FY 2023-24 to support various health care degree programs at ECU including expanding the Brody School of Medicine class size by 40 students and doubling the size of the Physician Assistant program.
- $4.8 million in the first year of the biennium and $6.3 million in the second year to the North Carolina Association of Free and Charitable Clinics to support member clinics that provide health care for the uninsured and underserved
- $12.5 million nonrecurring in both years of the biennium for the Rural Health Care Stabilization Program which provides loans to eligible hospitals located in rural areas that are in financial crisis.
The enactment of the 2023-25 biennial budget also served as the trigger for the expansion of Medicaid in North Carolina. A top priority of Governor Roy Cooper and legislative democrats for the last several years, Medicaid expansion provides Medicaid coverage through the state’s NC Health Works programs to adults aged 18-64 with incomes up to 133% of the federal poverty level. The North Carolina General Assembly passed HB 76: Access to Healthcare Options on March 23, 2023, and the Governor signed the bill into law on March 27, 2023, however, HB 76 included a provision that required the budget bill to become law before taking effect. In addition to providing expanded Medicaid coverage to thousands of North Carolinians, the passage of Medicaid expansion drew down more than $1.4 billion from the federal government to be used to fund various workforce, capital, and other healthcare priorities throughout the state budget.
In addition to the passage of Medicaid Expansion and the biennial budget bill, legislators adopted a handful of other healthcare related bills, including:
- HB 125: NC Health & Human Services Workforce Act allows military relocation licenses for physician and physician assistant servicemembers and spouses, modifies over-the-counter hearing aid, behavior analyst credentialing, and optometry laws, updates the statutes governing the practice of audiology, and establishes the Hospital Violence Protection Act. HB 125 passed the Senate unanimously and the House in a final 107-3 vote. The bill was signed into law on November 29.
- HB 190: Dept. of Health and Human Services Revisions.-AB makes several technical and conforming changes to laws pertaining to DHHS such as clarifying duties of the Medical Care Commission, expand the professional who can serve as county medical examiners, lengthen the duration of the County Plan for Work First/Temporary Assistance for Needy Families, recognize child welfare training completed in another state, authorize opioid treatment program medication units and mobile units, among other provisions. HB 190 passed the Senate by a 45-2 vote and the House voted to concur in a 115-4 vote. The bill was signed into law by the Governor on June 29.
- HB 415: Stop Addiction Fraud Ethics Act of 2023 enacts new laws related to truth in marketing, and patient brokering and kickbacks, for substance use disorder treatment providers and facilities. HB 415 passed both chambers unanimously and was signed into law on October 20.
- HB 600: Regulatory Reform Act of 2023 makes various amendments to state laws and regulations. Specifically, related to healthcare issues, the bill codifies existing stroke center designations and adds thrombectomy-capable stroke center designations, clarifies state ownership of health information exchange network data, and allows chiropractors to voluntarily submit data to the Health Information Exchange Network. HB 600 passed the House in a 72-38 vote and the Senate in a 25-16 vote. The bill was vetoed by the Governor on October 2. On October 10, the House voted to override the governor’s veto 77-38 and the Senate voted to override the governor’s veto 30-18.
- HB 808: Gender Transition/Minors prohibits medical professionals from performing surgical gender transition procedures on minors and prescribing, providing, or dispensing puberty-blocking drugs or cross-sex hormones to minors, with some exceptions. Medical professionals who violate the provision would have their licenses revoked. The bill also prohibits state funds from being sued for surgical gender transition procedures on minors and prescribing, providing, or dispensing puberty-blocking drugs or cross-sex hormones to minors. HB 808 passed the Senate by a 29-16 vote and the House by a 67-46 vote. The bill was vetoed by the Governor on July 5. On August 16, the House voted to override the governor’s veto 74-45 and the Senate voted to override the governor’s veto 27-18.
- HB 815: The Loving Homes Act allows a foster home which otherwise qualifies for family foster home licensure but for having five children residing in the home to provide care for one foster child or sibling group. HB 815 passed both chambers unanimously and was signed into law on July 7.
- SB 20: Care for Women, Children, and Families Act repeals and replaces the current abortion law in North Carolina such that, under the new law, abortion would be permitted through the first twelve weeks of pregnancy for any reason, through the twentieth week of pregnancy if the pregnancy resulted from rape or incest, through the twenty-fourth week of pregnancy if there is a life-limiting anomaly in the unborn child, and at any time if there is a medical emergency for the pregnant woman. The bill also criminalizes the provision or advertising of abortion-inducing drugs, prohibits eugenic abortions, and establishes informed consent and reporting requirements for abortions provided. SB 20 passed the House 41-46 and the Senate by a 29-20 vote. The bill was vetoed by the Governor on May 14. On May 16, the Senate voted to override the governor’s veto 30-20 and the House voted to override the governor’s veto 72-18.
- SB 291: QRIS/Star Rating System Reform extends the pause in requiring ERS assessments if the assessment would result in the licensed childcare facility losing a star rating through June 30, 2024, and requires the Division of Child Development and Early Education to maintain the reduced threshold percentage of lead teachers in the program required when the ERS assessments resume, through June 30, 2026. The bill also requires the North Carolina Child Care Commission to complete recommendations for QRIS/Star Rating reform by March 31, 2024, and submit those recommendations to the Joint Legislative Oversight Committee on Health and Human Services before the 2024 legislative session begins. SB 291 passed both chambers unanimously and was signed into law on June 12.
While many healthcare-related bills did not ultimately make it across the finish line before the long session adjourned, several still remain eligible for upcoming short session beginning April 24, including:
- HB 35: Expand Definition of Opioid Antagonist would broaden the definition of opioid antagonist to include all opioid antagonists approved by the federal Food and Drug Administration to treat drug overdoses. HB 35 passed the House unanimously but was never taken up by the Senate.
- HB 75: PA Team-Based Practice would allow certain physician assistants in team-based settings to practice without direct supervision by a physician and would allow PAs to prescribe drugs, initiate non-pharmacological therapies, certify medical documents, perform health assessments for childcare facilities, among other provisions. HB 75 passed the House unanimously before being amended on the Senate floor to require the enactment of medical marijuana legislation, SB 3: NC Compassionate Care Act, prior to the provisions in HB 75 going into effect. The amended version of HB 75 passed the Senate 37-7. The House voted not to concur with the Senate amendment. A conference committee has not yet been appointed to negotiate the differences between the two chamber’s versions of the bill.
- HB 150: School Contracted Health Services would allow children with disabilities who received services prior to enrolling in school to continue receiving services from their previous provided while at school. HB 150 passed the House 109-4 but was never taken up by the Senate.
- HB 246: Revise Pharmacy Benefits Manager Provisions would prohibit pharmacy benefits managers (PBMs) from reimbursing pharmacies less than the national average cost of a drug or less than the pharmacy benefits manager would reimburse itself. PBMs would also be prohibited from assessing certain fees and would have to submit quarterly reports to the Department of Insurance. HB 246 passed the House unanimously but was never taken up by the Senate.
- HB 576: Health Care Practitioner Transparency Act would require a healthcare practitioner’s licensure, certification, or registration to be displayed on advertisements and required identification and would prohibit any deceptive or misleading representations about a healthcare practitioner’s license, certification, or registration. HB 576 passed the House 111-5 but was never taken up by the Senate.
- SB 46: Medical Billing Transparency would require healthcare facilities to notify patients of any healthcare providers at the facility who may not be in the patients’ insurance network. SB 46 passed the Senate unanimously but was never taken up by the House.
- SB 321: Medical Debt De-Weaponization Act would require large healthcare facilities to provide patients with a financial assistance policy, prevent them from taking extraordinary collection measures, provide price information on their websites, and report to DHHS on their action towards complying with these measures. Consumers would have a private right of action against healthcare facilities and medical debt collectors who violate the bills’ provisions and the bill would prohibit most non-hospital healthcare facilities from charging facility fees. SB 321 passed the Senate unanimously but was never taken up by the House.
Upcoming Legislative Meetings
Monday, February 12
1:00 PM House: Select Committee on Education Reform
Tuesday, February 13
10:00 AM House: Select Committee on Substance Abuse
1:00 PM House: Select Committee on Homeowners’ Associations
Wednesday, February 14
12:00 PM House: Session Convenes
12:00 PM Senate: Session Convenes