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), MD Timothy Reeder (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
7 provisions identified: 4 benefits, 1 costs, 2 mixed.
Hospital assessments: base, amounts, timing
Starting April 1, 2024, home and community-based services count in the assessment base. The law sets presumptive service cost amounts: $0 before the effective quarter, $48.75 million times the number of months in the effective quarter, and $146.25 million in the next quarter. Most assessment subsections take effect on the first day of the next assessment quarter after this law becomes law; other parts take effect at enactment. The law also repeals Section 9D.13(c) of S.L. 2021-180.
Adult care homes: personal care option
The state will ask federal CMS to let Medicaid cover personal care 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 the federal poverty level (basic rate) or 200% (enhanced rate). DHB must send the request within 90 days. Coverage starts only if CMS approves and the plan is cost-neutral and lawful.
Medicaid paused, not ended, in jail
The state suspends Medicaid when a person is incarcerated instead of ending it. This keeps eligibility active so coverage can restart quickly after release. DHHS works with county jails and NCFAST to share data. DHHS must report progress by October 1, 2025.
Team-based Medicaid care for addiction
Medicaid now offers a team-based service for substance use care. It includes screening, medicines for alcohol and opioid use disorders, recovery support, and case management. The state also runs a campaign to teach and train providers and community leaders. The goal is to add more Medicaid providers and improve access to care statewide.
One statewide plan for foster youth
By December 1, 2025, DHHS must issue an RFP for a single statewide Children and Families specialty Medicaid plan. When the plan starts, children in foster care, adoption assistance recipients, and former foster youth move into that plan under state law. This may change which plan manages services and provider networks for these groups.
Easier Medicaid enrollment for telehealth providers
Providers licensed in North Carolina who offer care only by telehealth can enroll in Medicaid without a physical in-state location. Telehealth-only provider groups also do not need an in-state service address. This removes an enrollment barrier for telehealth businesses.
New rules for psychiatric hospital payments
The state will ask federal CMS to let freestanding psychiatric hospitals join the HASP program for higher reimbursements. These hospitals must also pay new quarterly assessments based on a percentage of their hospital costs. The percentage is set from the related HASP component and total costs for all such hospitals. If CMS approves, higher payments start; assessments apply as set in law.
Sponsors & Cosponsors
Sponsors
Allen Chesser
Republican • House
MD Timothy Reeder
Republican • House
Heather H. Rhyne
Republican • House
Donna McDowell White
Republican • House
Cosponsors
Jonathan L. Almond
Republican • House
MD Grant L. Campbell
Republican • House
Becky Carney
Democratic • House
Todd Carver
Republican • House
Maria Cervania
Democratic • House
Charles Smith
Democratic • House
Sarah Crawford
Democratic • House
Brent Jackson
Republican • Senate
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
Jr. A. Reece Pyrtle
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
Actions Timeline
Ch. SL 2025-64
7/7/2025HouseSigned by Gov. 7/7/2025
7/7/2025HousePres. To Gov. 6/27/2025
6/27/2025HouseRatified
6/26/2025HouseOrdered Enrolled
6/25/2025HouseConcurred On 3rd Reading
6/25/2025HouseConcurred On 2nd Reading
6/24/2025HousePlaced On Cal For 06/24/2025
6/23/2025HouseCal Pursuant 36(b)
6/19/2025HouseRuled Material
6/19/2025HouseSpecial Message Received For Concurrence in S Com Sub
6/19/2025HouseSpecial Message Sent To House
6/19/2025SenatePassed 3rd Reading
6/19/2025SenatePlaced On Cal For 06/19/2025
6/18/2025SenateWithdrawn From Cal
6/18/2025SenatePassed 2nd Reading
6/17/2025SenateReptd Fav
6/16/2025SenateRe-ref Com On Rules and Operations of the Senate
6/10/2025SenateCom Substitute Adopted
6/10/2025SenateReptd Fav Com Substitute
6/10/2025SenateRe-ref Com On Finance
6/5/2025SenateCom Substitute Adopted
6/5/2025SenateReptd Fav Com Substitute
6/5/2025SenateRe-ref to Health Care. If fav, re-ref to Finance. If fav, re-ref to Rules and Operations of the Senate
5/29/2025SenateWithdrawn From Com
5/29/2025Senate
Bill Text
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Latest Edition
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