All Roll Calls
Yes: 579 • No: 7
North CarolinaHB 6962025-2026 SessionHouseWALLET
Medicaid and HHS Adjust./Other Critical Needs.
Sponsored By: Grant L. Campbell, MD (Republican), Larry W. Potts (Republican), Timothy Reeder, MD (Republican)
Signed by Governor
ADMINISTRATIVE CODEADMINISTRATIVE RULESADVERTISING & MARKETINGALTERNATIVE MEDICINECHIROPRACTORSCOMMUNICATIONSCOUNSELINGDENTISTS & DENTISTRYEMPLOYMENTFOODS & BEVERAGESHEALTH SERVICESMENTAL HEALTHNURSES & NURSINGNUTRITIONOCCUPATIONAL THERAPYOCCUPATIONSOPTICIANS & OPTOMETRISTSPERSONNELPHARMACEUTICALSPHARMACISTS & PHARMACIESPHYSICAL THERAPYPHYSICIANSPRESENTEDPSYCHIATRYPSYCHOLOGYPUBLICPUBLIC HEALTHRATIFIEDSPEECH PATHOLOGISTS & AUDIOLOGISTSCHAPTEREDOPTHALMOLOGY & OPTHALMOLOGISTS
Personalized for You
How does this bill affect your finances?
Personalize government policy and PRIA will tell you what this bill means for your household, plus every other piece of legislation we track. PRIA reads each provision against your financial profile to show you exactly what matters to your wallet.
Bill Overview
Analyzed Economic Effects
31 provisions identified: 12 benefits, 5 costs, 14 mixed.
Set DME pay rates under Medicaid
From July 1, 2025 through June 30, 2027, Medicaid managed care pays suppliers for DME, orthotics, and prosthetics at 100% of the lesser of the supplier’s usual charge or the Medicaid fee‑for‑service maximum. This sets a clear payment floor and gives suppliers more certainty.
Funds to keep justice system running
Beginning April 30, 2026, the law gives $80 million one time in FY 2025–26 to the Department of Adult Correction. The SBI gets $2.5 million each year starting in FY 2025–26 and $1.2 million one time for FY 2025–26. The courts get $165,000 one time to extend Business Court case‑management software. The General Assembly gets $1.5 million one time for FY 2025–26 operating costs.
Targeted funds for airports and local projects
Beginning April 30, 2026, $10.2 million and $35 million go to the Piedmont Triad Airport Authority for listed construction, demolition, infrastructure, and related costs; the Department may reallocate surplus among listed areas. Hertford may use earlier water‑capacity funds for any water or wastewater project. Any leftover of a $2 million Mayland grant is split equally between Avery and Mitchell Counties for lawful public uses. An Iredell $5 million grant is split: $3 million for a new county safety building and $2 million to Statesville for water and wastewater tied to economic development.
Medicaid gets new funding and audits
The law provides $319 million one‑time for FY 2025–26 (retroactive to July 1, 2025) to adjust Medicaid funding and launch the Children and Families Specialty Plan. Local behavioral‑health plans must make intergovernmental transfers totaling $18,028,217 in both 2025–26 and 2026–27, with shares that the Division may reassign as counties realign. The State Auditor must run a performance audit of Medicaid and NCWorks, funded with a $500,000 one‑time appropriation in FY 2026–27.
Easier financing for airport megaproject
Beginning April 30, 2026, federal and foreign government funds can count toward the $4.5 billion investment needed for a qualifying transformative project at the airport site. With approval from the Economic Investment Committee, a benefitted business may also use project land or improvements as collateral for financing. Collateral cannot include land or improvements funded under the listed excluded subdivisions.
Medicaid copays set to federal max
Beginning July 1, 2027, the State sets Medicaid copays each year at the highest levels federal law allows. This can raise what you pay out of pocket for covered services.
Stricter SNAP proof and income counting
Starting April 30, 2026, self‑attestation alone is not accepted to prove SNAP eligibility unless federal law requires it. The State must fully count the income and resources of any person found ineligible under 7 U.S.C. § 2015(f) when setting household eligibility and benefit size. The State may not prorate or exclude that person’s income or resources.
Tighter Medicaid checks and noncitizen limits
Starting October 1, 2026, the State checks facts that affect Medicaid eligibility every month. Self‑attestation alone is not accepted to prove eligibility unless federal law or a court requires it. The State must count the income of household members who are ineligible due to immigration status when deciding eligibility. Noncitizens only get the Medicaid coverage that federal law requires, and people with emergency‑only eligibility are not covered by broader managed‑care benefits.
New rules for autism therapy on Medicaid
Paraprofessionals do not need Medicaid credentialing and have 120 days from hire (or employer enrollment) to earn RBT or ABAT certification; services in that period must be supervised by a licensed autism provider. Paraprofessional services cannot be done by telehealth; autism assessments by licensed providers must be in person. Licensed provider observation and direction by telehealth is capped at 50% of their services per person, unless the State allows an exception. Parent and caregiver training may be done by telehealth. If one provider gives over 200 paraprofessional hours in six months, 10% to 20% of those hours must be licensed‑provider time (more than 20% needs medical‑necessity notes). Repeated noncompliance can lead to payment recoupment and then a 1–2 year billing suspension. Out‑of‑state supervisors cannot enroll as Medicaid providers.
New rules for Medicaid autism services
Any plan for ABA services over 16 hours a week must be approved by the health plan or the Department and reapproved monthly. At least 10% of paraprofessional service hours must include observation and direction by a licensed autism provider. The Division can allow case‑by‑case exceptions to telehealth and supervision limits for medical need or poor access, with changes added to coverage policy and reported to lawmakers.
New rules for Medicaid plan networks
Medicaid plans must keep an open network and include providers the State marks as essential. Plans may create a closed network for a service only with State approval; if the State does not answer in 180 days, it is approved. Behavioral health and IDD tailored plans must meet the same network rules and include essential providers. For services picked to improve access, plans must accept providers that meet quality rules and accept network rates. Children and Families specialty plans run closed networks for certain intensive services and cannot exclude tribal or Indian Health Service providers. Plans can still exclude non‑essential providers that fail quality standards or refuse network rates.
Overnight respite limits and staffing rules
Starting July 1, 2026, adults can use no more than 14 straight nights and no more than 60 total overnight respite days in any 365‑day period, unless a listed waiver allows more. Facilities must keep awake staff on duty: at least one for 1–6 people and at least two for 7–12, with medication and personal care training as required. Staff who do personal care cannot do housekeeping or food service during that shift.
Stricter Medicaid reviews and safety-net protections
Medicaid health plans can run prepayment claim reviews without prior Department approval and must copy the Department on provider notices. A plan may remove a provider that fails the 80% clean‑claims test once the Department approves the request; if the Department does not answer in 90 days, the removal is approved. The Department also designates key safety‑net providers (like FQHCs, rural health centers, free clinics, local health departments, and State Veterans Homes) as essential so networks keep access; physicians are not labeled essential. The Division must develop a Medicaid improvement plan, not before July 1, 2027, that may align hospital rates, add GLP‑1 weight‑loss guardrails, improve reporting, and streamline credentialing.
More aid for veterans’ children scholarships
The law adds $1 million one time in 2025–26 to raise Children of Wartime Veterans scholarship awards back to the full allowed amounts. Beginning in 2026–27, it provides $10 million each year from the Escheat Fund to support more scholarships. If money is still not enough in a given year, the Authority may standardize awards, use a lottery, and give pro rata room-and-board awards to share funds among eligible students.
More help and rules for veterans’ kids
For 2026–27, the Secretary may raise new Class II and III scholarship awards from 100 to 200 each. For 2025–26, the Secretary may prioritize Class I‑A, I‑B, and IV before II and III; for 2026–27, new undergraduate resident applicants may be prioritized. Notices must say awards depend on available funds. The Authority may use Escheat Fund money, after consulting the Secretary, to fund additional eligible students at public colleges. The Authority may use up to 2.5% of its General Fund allocation for admin, and unused appropriations go to a trust fund for future awards and admin. For 2025–26, the Secretary may reduce room and board allowances if decided by August 15, 2025; for 2026–27, the Secretary may set a standard payment schedule within available funds.
NC 529 rules match federal law
For North Carolina 529 college savings plans, the law defines the “Code” to mean federal tax law as of July 4, 2025. This change sets which education costs qualify under NC 529 plans to match federal rules in effect on that date. Some expenses may newly qualify, while others may no longer qualify, depending on federal changes.
Stricter reviews of Medicaid provider claims
The State must mail written notice before starting a prepayment review. A provider leaves review only after three straight months with an 80% clean‑claims rate and at least half of prior average claim volume; missing this in six months can lead to sanctions or termination. Providers cannot withhold claims to avoid review; claims from the review period can still be checked before payment. Plans may require itemized bills for inpatient outlier claims that are $250,000 or more or far above the median for the code.
Hospital assessments and admin funding changes
The State updates formulas for hospital assessments and intergovernmental transfer (IGT) reconciliations. It sets CPI‑indexed base admin amounts: State $4,187,700 per quarter in 2024–25 and county $7,800,000 per quarter in 2025–26, with annual CPI increases after 2025–26. Starting July 1, 2026, the supplemental admin component is counted in receipts and adjustments, and proceeds equal to base plus supplemental county amounts fund county DSS eligibility work; State admin use is capped at base plus supplemental State amounts and matching federal funds. The public‑hospital assessment percentage starts July 1, 2026, and new IGT receipts adjustment formulas apply October 1, 2026. The law sets the State and county supplemental admin quarterly amounts to $0 starting two years after a linked report’s submission; if no report by July 1, 2034, that change expires July 1, 2034.
Hospital assessments and admin funding changes
Hospitals owe a one‑time 2026 assessment, with a statewide target of $14.3 million minus intergovernmental transfer receipts; each hospital’s share is set by formula. The Department sets due dates, marks payments late after seven days, may withhold Medicaid payments, and cannot let hospitals add this assessment to patient bills. Assessment and IGT receipts go to a special fund, including $7.8 million for county social services’ added admin costs. A new supplemental admin schedule pays State and county amounts by quarter, grows with CPI through 2035–36, and ends for fiscal years starting July 1, 2036. The Division must choose a HASP method that maximizes federally‑approved hospital reimbursements and must report if reimbursements or IGTs fall below set thresholds. The law also defines public‑hospital IGT offsets, requires a 2029 report to true‑up admin costs and propose credits, and requires reports on cost‑lowering changes and long‑term funding options.
New formula for public hospital assessments
Starting July 1, 2026, the quarterly assessment rate for public acute care hospitals equals the modernized IGT actual receipts adjustment component divided by total public hospital costs for the quarter. This sets how the State calculates each quarter’s assessment share for public hospitals. It changes hospital financing but does not allow hospitals to pass assessments as patient surcharges under other provisions of law.
More beds at overnight respite centers
Starting July 1, 2026, each licensed overnight respite facility can have up to 12 beds, up from 6. This can increase access to short‑term care for families and caregivers.
Money to cover DMV shortfall
Beginning April 30, 2026, the DMV gets $13.1 million each year starting in FY 2025–26 and $8.5 million one time for FY 2025–26. The money covers an operating shortfall from lower‑than‑expected credit‑card fee receipts.
More time to use state grants
Directed grants from 2023–24 and 2024–25 do not revert until June 30, 2027. The rules that govern those grants also stay in force through June 30, 2027. Funds named in S.L. 2025‑4, Section 1.1(a), that were unspent on December 31, 2024 now revert at the end of the 2026–27 fiscal year. Recipients get more time to use their money.
Study to centralize social services
Starting April 30, 2026, the budget office and DHHS must hire a contractor to study moving all mandated social services under State administration. The RFP is due by October 31, 2026, and the report is due by June 30, 2027. The law provides $1,000,000 one time in FY 2026–27 to pay for the study.
More money for parks and water
Beginning April 30, 2026, $1.6 million is redirected to Harnett County to renovate parks, improve safety and access, and build trails and green space. Any unspent funds from the Western NC Megasite water and wastewater grant are reallocated to Burke County for water and wastewater projects.
State commission studies public education
The law creates a 29‑member Blue Ribbon Commission on Public Education to study how public education is structured and run. Members may receive per diem and travel, and get staff support from the Friday Institute and Legislative Services. It ends March 1, 2027. The law provides $300,000 (available through June 30, 2027) to the Friday Institute to run the Commission.
Selma grant moved to county development group
Beginning April 30, 2026, the $800,000 grant for project recruitment is moved from the Town of Selma to the Johnston County Economic Development Corporation. The purpose stays the same: recruiting economic development projects.
Work rules for some Medicaid adults
Beginning January 1, 2027, the Department applies community‑engagement (work) rules when federal officials allow them. At application, you must show proof of compliance for the three straight months before you applied. At renewal, you must show proof for at least three of the last six months before your renewal month.
Unverified status cases sent to Homeland Security
The Department must promptly refer any applicant or recipient whose citizenship or satisfactory immigration status cannot be verified to the U.S. Department of Homeland Security. Referral also occurs if checks show the person is not a U.S. citizen or lacks satisfactory status and entered without inspection or overstayed an authorized stay. This adds enforcement risk for affected applicants and recipients.
DMV budgets must match card-fee receipts
Beginning April 30, 2026, the budget office and the DMV must align credit‑card receipt line items with actual collections. The DMV must update its card‑fee collection projections and base budget to match real receipts. This is an internal budgeting rule that may affect future DMV funding.
Some Medicaid changes end after 2027
Changes to Medicaid made by this part of the law end after June 30, 2027, unless another law keeps them. The health agency does not have to continue those modifications after that date.
Sponsors & Cosponsors
Sponsors
Grant L. Campbell, MD
Republican • House
Larry W. Potts
Republican • House
Timothy Reeder, MD
Republican • House
Cosponsors
Cody Huneycutt
Republican • House
Bill Ward
Republican • House
Roll Call Votes
House vote • 4/28/2026
HB 696: Medicaid & HHS Adjust./Other Critical Needs.
Yes: 113 • No: 2 • Other: 5
Senate vote • 4/28/2026
HB 696: Medicaid & HHS Adjust./Other Critical Needs.
Yes: 45 • No: 3 • Other: 2
Senate vote • 4/22/2026
HB 696: Medicaid & HHS Adjust./Other Critical Needs.
Yes: 48 • No: 1 • Other: 1
House vote • 4/22/2026
HB 696: Medicaid & HHS Adjust./Other Critical Needs.
Yes: 112 • No: 1 • Other: 7
House vote • 6/24/2025
HB 696: Health Care Practitioner Transparency Act.
Yes: 111 • No: 0 • Other: 9
Senate vote • 6/19/2025
HB 696: Health Care Practitioner Transparency Act.
Yes: 41 • No: 0 • Other: 9
House vote • 5/6/2025
HB 696: Health Care Practitioner Transparency Act.
Yes: 109 • No: 0 • Other: 9
Actions Timeline
Ch. SL 2026-1
4/30/2026HouseSigned by Gov. 4/30/2026
4/30/2026HousePres. To Gov. 4/28/2026
4/28/2026HouseRatified
4/28/2026HouseOrdered Enrolled
4/28/2026HouseConf Report Adopted 3rd
4/28/2026SenateConf Report Adopted 3rd
4/28/2026HousePlaced On Cal For 04/28/2026
4/22/2026SenateConf Report Passed 2nd
4/22/2026SenatePlaced On Cal For 04/28/2026
4/22/2026HouseConf Report Adopted 2nd
4/22/2026HousePlaced On Cal For 04/22/2026
4/21/2026HouseRuled Material
4/21/2026HouseConf Com Reported
4/21/2026HousePlaced On Cal For 04/22/2026
4/21/2026SenateHeld As Material
4/21/2026SenateConf Com Reported
4/21/2026SenateConferees Changed
4/21/2026HouseConf Com Appointed
6/25/2025SenateConf Com Appointed
6/24/2025HouseFailed Concur In S Com Sub
6/24/2025HouseAdded to Calendar
6/24/2025HouseWithdrawn From Com
6/24/2025HouseRe-ref Com On Rules, Calendar, and Operations of the House
6/23/2025HouseWithdrawn From Cal
6/23/2025House
Bill Text
Edition 1
Edition 2
Edition 3
Edition 4
Filed
Latest Edition
Related Bills
HB 562, Budget Technical Corrections Modifications.
HB 268, 2026 Budget Technical Corrections - II.
SB 445, Regulatory Reform Act of 2026.
HB 147, Various Local Provisions XI.
HB 116, Jacksonville Annexation and Conforming Changes.
SB 1092, AN ACT TO APPOINT PERSONS TO VARIOUS PUBLIC OFFICES UPON THE RECOMMENDATIONS OF THE PRESIDENT PRO TEMPORE OF THE SENATE AND THE SPEAKER OF THE HOUSE OF REPRESENTATIVES AND TO MAKE CORRECTIONS TO PREVIOUS APPOINTMENTS.