All Roll Calls
Yes: 424 • No: 0
North CarolinaHB 5462025-2026 SessionHouseWALLET
AN ACT TO REQUIRE TEAM-BASED CARE COORDINATION IN MEDICAID SUBSTANCE USE TREATMENT AND TO MODIFY THE MEDICAID PROGRAM TO SUSPEND RATHER THAN TERMINATE MEDICAID ELIGIBILITY FOR INCARCERATED INDIVIDUALS.
Sponsored By: Allen Chesser (Republican), Timothy Reeder, MD (Republican), Heather H. Rhyne (Republican), Donna McDowell White (Republican)
Signed by Governor
CHILD CUSTODYCONTRACTSCORRECTIONAL INSTITUTIONSDEFINITIONSDHHSFOSTER CAREHEALTH SERVICESHOSPITALSINSURANCE, HEALTHMEDICAIDMENTAL HEALTHMINORSPOVERTYPREGNANCYPRESENTEDINMATESPUBLICPUBLIC HEALTHRATIFIEDSESSION LAWSSOCIAL SERVICESTITLE CHANGEWOMENSUBSTANCE ABUSECHAPTEREDFAMILY ISSUESADULT CORRECTION DEPT
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Bill Overview
Analyzed Economic Effects
8 provisions identified: 5 benefits, 1 costs, 2 mixed.
Medicaid personal care for more residents
The state must ask federal CMS to cover personal care services for people in licensed adult care homes and special care units. Income must be above the State‑County Special Assistance limit but at or below 180% of poverty (basic) or 200% (enhanced). The state can start coverage only if CMS approves and the plan is cost‑neutral. If approved, eligible residents can get help and pay less out of pocket.
Planning for Medicaid work rules
If federal officials indicate they will allow Medicaid work requirements, the state must negotiate a plan. The state must notify lawmakers within 30 days of starting talks and report details within 30 days of any federal approval. If CMS approves, the state implements the approved work requirements.
New hospital fees and payment formulas
The law changes how all public and private acute care hospitals are charged each quarter. Each hospital’s modernized and health advancement assessment percentages are set by statewide collection amounts and the hospital’s historical share. It defines an acute care payment component for newly eligible people and removes freestanding psychiatric components from acute care totals. It sets the presumptive service cost at $48.75 million times the months in the start quarter, $146.25 million the next quarter, and later uses the largest of several inflation or capitation measures. It updates reconciliation and intergovernmental transfer math with a two‑quarter lookback and a public hospital cost share using UNC, ECU, and 60% of other public acute care hospital costs; related adjustments now subtract both acute and freestanding psychiatric components and tax offsets. It also revises which items count as nonfederal receipts, adds home‑ and community‑based services from April 1, 2024, removes the prior end date for the postpartum component in that calculation, and repeals a prior session‑law subsection.
Medicaid paused, not ended, in jail
If you are on Medicaid and are incarcerated, the state suspends your Medicaid instead of ending it. Your coverage can resume after release, as allowed by federal law.
Team-based Medicaid care for addiction
The law creates a team-based care service in Medicaid for substance use. It must cover screening for alcohol and opioid use disorders and other mild to moderate substance use. It must include medicines for opioid and alcohol use, recovery supports, and case management. The state also runs a campaign to teach and train providers and community leaders to grow access.
Psych hospitals join hospital payment program
The law adds freestanding psychiatric hospitals to the state’s hospital payment program, if CMS approves. These hospitals can receive directed payments and must pay new quarterly assessments based on total costs. The law defines which facilities qualify and how the quarterly percent is set. The state must file a federal preprint to request CMS approval.
Single plan for foster care Medicaid
The state must request proposals by December 1, 2025, for one statewide Children and Families specialty plan. Until that plan starts, children in foster care, adoption assistance recipients, and eligible former foster youth keep current Medicaid rules. When the plan begins, these groups move into the CAF plan under state law.
Easier Medicaid sign‑up for telehealth
A North Carolina‑licensed provider who only offers telehealth does not need a physical office in the state to enroll in Medicaid. Telehealth‑only provider groups with NC‑licensed members do not need an in‑state service address either. This removes an enrollment hurdle and can expand patient access.
Sponsors & Cosponsors
Sponsors
Allen Chesser
Republican • House
Timothy Reeder, MD
Republican • House
Heather H. Rhyne
Republican • House
Donna McDowell White
Republican • House
Cosponsors
Jonathan L. Almond
Republican • House
Grant L. Campbell, MD
Republican • House
Becky Carney
Democratic • House
Todd Carver
Republican • House
Maria Cervania
Democratic • House
Charles Smith
Democratic • House
Sarah Crawford
Democratic • House
Frances Jackson, PhD
Democratic • House
Julia Greenfield
Democratic • House
Pricey Harrison
Democratic • House
Donnie Loftis
Republican • House
Jeffrey C. McNeely
Republican • House
Larry W. Potts
Republican • House
Renée A. Price
Democratic • House
A. Reece Pyrtle, Jr.
Republican • House
Phil Rubin
Democratic • House
Bill Ward
Republican • House
Shelly Willingham
Democratic • House
Roll Call Votes
House vote • 6/25/2025
HB 546: Medicaid Modernization.
Yes: 112 • No: 0 • Other: 5
House vote • 6/24/2025
HB 546: Medicaid Modernization.
Yes: 111 • No: 0 • Other: 6
Senate vote • 6/19/2025
HB 546: Medicaid Modernization.
Yes: 42 • No: 0 • Other: 8
Senate vote • 6/17/2025
HB 546: Medicaid Modernization.
Yes: 46 • No: 0 • Other: 4
House vote • 5/6/2025
HB 546: Inmate Medicaid Suspension/Team-Based Care.
Yes: 113 • No: 0 • Other: 7
Bill Text
Edition 1
Edition 2
Edition 3
Edition 4
Edition 5
Filed
Latest Edition
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