Chapter 108A

(a) The Department of Health and Human Services is expressly authorized and required to take any and all necessary action to amend the State Plan and waivers in order to keep the program within the certified budget, except as provided in G.S. 108A-54(f). For purposes of this sect…

(a) Repealed by Session Laws 2022-74, s. 9D.15(g), effective April 1, 2023. (b) Repealed by Session Laws 2022-74, s. 9D.15(g), effective April 1, 2023. (c) Prior to filing a temporary rule authorized under G.S. 150B-21.1(a)(17) with the Rules Review Commission and the Office of A…

(a) The Department shall adopt rules to develop, amend, and adopt medical coverage policy for Medicaid in accordance with this section. (b) Medical coverage policy is defined as those policies, definitions, or guidelines utilized to evaluate, treat, or support the health or devel…

(a) The Department shall provide Medicaid coverage for individuals in accordance with federal statutes and regulations and specifically shall provide coverage, subject to the limitation in subsection (c) of this section, for the following populations: (1) Families, children under…

(a) As used in this section, the following definitions apply: (1) Cost. - All expenses incurred by the State and counties that are eligible for Medicaid federal financial participation. (2) NC Health Works. - The provision of Medicaid coverage to the individuals described in G.S.…

If the federal medical assistance percentage for Medicaid coverage provided to the category of individuals described in G.S. 108A-54.3A(a)(24) falls below ninety percent (90%), then Medicaid coverage for this category of individuals shall be discontinued as expeditiously as possi…

An increase in a Medical Assistance Program recipient's income due solely to a cost-of-living adjustment to federal Social Security and Railroad Retirement payments shall be disregarded when determining income eligibility for the Medical Assistance Program. This section shall not…

The Department of Health and Human Services shall ensure that the eligibility criteria for Medicaid home- and community-based waivers allow the dependent of a member of the Armed Forces of the United States to maintain the dependent's waiver status upon the transfer of the servic…

(a) The Department may authorize, within appropriations made for this purpose, payments of all or part of the cost of medical and other remedial care for any eligible person when it is essential to the health and welfare of such person that such care be provided, and when the tot…

The Department shall require State Medical Assistance Program recipients who qualify for Medicare to enroll in Medicare, in accordance with Title XIX of the Social Security Act, in order to pay medical expenditures that qualify for payment under Medicare Parts B and D, except tha…

The Department shall work with the Department of Public Instruction and local education agencies to develop efficient, effective, and appropriate administrative procedures and guidelines to provide maximum funding for Medicaid-related services for Medicaid-eligible students with …

(a) At the time of application for medical assistance benefits, the applicant shall provide satisfactory proof that the applicant is a resident of North Carolina and that the applicant is not maintaining a temporary residence or abode incident to receiving medical assistance unde…

(a) As used in this section, the terms: (1) "Applicant" means an applicant or former applicant of medical assistance benefits. (1a) "Department" means the Department of Health and Human Services. (2) "Division" means the Division of Health Benefits of the Department of Health and…

(a) On at least a monthly basis, the Department shall review information concerning changes in circumstances that may affect medical assistance beneficiaries' eligibility to receive medical assistance benefits. The Department shall share the information directly with, or make the…

Except as required by federal law or regulation, or pursuant to a court order, the Department or a county department of social services shall not accept self-attestation as the only evidence in verification of eligibility requirements for the North Carolina Medicaid program. (202…

(a) As long as work requirements as a condition of participation in the Medicaid program may be authorized by the Centers for Medicare and Medicaid Services, the Department shall take all actions necessary to implement and maintain implementation of those work requirements to the…

Except as otherwise provided by federal law or regulation, the income of a household member who is ineligible for medical assistance benefits due to the household member's immigration status shall be counted when calculating and determining an individual's financial eligibility f…

All of the provisions of the federal Social Security Act providing grants to the states for medical assistance are accepted and adopted, and the provisions of this Part shall be liberally construed to effectuate compliance with the act, except to the extent the applicability of f…

(a) As used in this section, the term "beneficiary" means (i) the beneficiary of medical assistance, including a minor beneficiary, (ii) the medical assistance beneficiary's parent, legal guardian, or personal representative, (iii) the medical assistance beneficiary's heirs, and …

Any recipient of medical assistance who moves from one county to another county of this State shall continue to receive medical assistance if eligible. The county director of social services of the county from which the recipient has moved shall transfer all necessary records rel…

(a) General Rule. - Except as otherwise provided herein, an individual who is otherwise eligible to receive medical assistance under this Part is ineligible for Medicaid coverage and payment for the services specified in subsection (d) during the period specified in subsection (c…

(a) Prior to imposition of a period of ineligibility for long-term care services because of an asset transfer, also known as a penalty period, the county department of social services shall notify the individual of the individual's right to request a waiver of the penalty period …

The Department shall annually establish all Medicaid copayments at the maximum allowable under federal law. (2026-1, s. 3C.16(a).)

(a) Notwithstanding any other provisions of the law, by accepting medical assistance, the recipient shall be deemed to have made an assignment to the State of the right to third party benefits, contractual or otherwise, to which he may be entitled. It shall be the responsibility …

Appointments to fill vacancies shall be made in the manner set out in G.S. 108A-3. All such appointments shall be for the remainder of the former member's term of office and shall not constitute a term for the purposes of G.S. 108A-4. (1917, c. 170, s. 1; 1919, c. 46, s. 3; C.S.,…

(a) It shall be unlawful for any person: (1) To willfully commingle or cause or solicit the commingling of the personal funds or moneys of a recipient resident of a provider health care facility with the funds or moneys of such facility; or (2) To willfully embezzle, convert, or …

Notwithstanding any other provisions of the law, for the purpose of determining eligibility for medical assistance under Title XIX of the Social Security Act, 42 U.S.C. § 1396 et seq., the income and financial resources of the natural or adoptive parents of a person who is under …

(a) A medical assistance beneficiary at an intermediate care facility or skilled nursing facility may take therapeutic leave in accordance with this section without the facility losing reimbursement under the medical assistance program. (b) The maximum amount of therapeutic leave…

(a) It shall be unlawful for any provider of medical assistance under this Part to knowingly and willfully make or cause to be made any false statement or representation of a material fact: (1) In any application for payment under this Part, or for use in determining entitlement …

(a) The Attorney General, acting through the Medicaid Investigations Unit of the Department of Justice, may, when engaged in an investigation of an alleged violation of G.S. 108A-63 and prior to the arrest of a suspect, issue in writing and cause to be served a subpoena to produc…

(a) It shall be unlawful for any person to knowingly and willfully and with intent to defraud make or cause to be made a false statement or representation of a material fact in an application for assistance under this Part, or intended for use in determining entitlement to such a…

The Department of Health and Human Services, Division of Health Benefits, shall provide incentives to counties that successfully recover fraudulently spent Medicaid funds by sharing State savings with counties responsible for the recovery of the fraudulently spent funds. (2013-36…

No later than October 1 of each year, the Department shall submit a report to the Joint Legislative Oversight Committee on Medicaid and the Fiscal Research Division. The report shall contain all of the following for the most recently concluded State fiscal year: (1) An accounting…

(a) It shall be unlawful for any person who is or has been an officer or employee of State or county government, and as such is or has been responsible for the expenditure of substantial amounts of federal, State or county money under the State medical assistance plan, or any per…

(a) Title. - This section may be cited as the Health Coverage for Workers With Disabilities Act. The Department shall implement a Medicaid buy-in eligibility category as permitted under P.L. 106-170, Ticket to Work and Work Incentives Improvement Act of 1999. The Department shall…

Qualified disabled working individuals are eligible for the payment of the Medicare Part A premium. An individual is qualified for this payment: (1) If the Social Security Administration determines the individual to be a "Disabled Working Individual"; (2) If the individual's inco…

Notwithstanding the provisions of Chapter 90 of the General Statutes or of any other provision of law, the Division of Health Benefits, Department of Health and Human Services, shall adopt rules implementing the drug use review provisions of the Omnibus Budget Reconciliation Act …

Prior authorization shall not be required or utilized for any antihemophilic factor drugs prescribed for the treatment of hemophilia and blood disorders where there is no generically equivalent drug available. Nothing in this section shall prohibit the Secretary from implementing…

(a) The Department of Health and Human Services shall establish and implement a preferred drug list program under the Division of Health Benefits. Medications prescribed for the treatment of mental illness shall be included on the Preferred Drug List (PDL). (b) The pharmaceutical…

(a) The Department shall provide immediate coverage under the Medicaid program of a new prescription medication approved by the Food and Drug Administration that becomes available to the public if (i) the manufacturer of that medication is enrolled in the federal Medicaid Drug Re…

(a) The following definitions apply in this section: (1) Covered substances. - Any controlled substance identified as an opioid or benzodiazepine, excluding benzodiazepine sedative-hypnotics, contained in Article 5 of Chapter 90 of the General Statutes, unless one of the followin…

(a) As used in this section and in G.S. 108A-70: (1) "Health benefit plan" means an accident and health insurance policy or certificate; a nonprofit hospital or medical service corporation contract; a health maintenance organization subscriber contract; a plan provided by a multi…

The board of social services of a county shall meet at least once per month, or more often if a meeting is called by the chairman. Such board shall elect a chairman from its members at its July meeting each year, and the chairman shall serve a term of one year or until a new chai…

(a) To the extent necessary to reimburse the Department or a PHP for expenditures for costs under this Part, and provided that claims for current and past due child support shall take priority over claims for those expenditures, the Department may garnish the wages, salary, or ot…

This Part may be cited as the Medical Assistance Provider False Claims Act. (1997-338, s. 1.)

Definitions. - As used in this Part: (1) "Attorney General" means the Attorney General or any Deputy, Assistant, or Associate Attorney General. (2) "Claim" means an application for payment or approval or for use in determining entitlement to payment presented to the Medical Assis…

(a) Liability for Certain Acts. - It shall be unlawful for any provider of medical assistance under the Medical Assistance Program to: (1) Knowingly present, or cause to be presented to the Medical Assistance Program a false or fraudulent claim for payment or approval; or (2) Kno…

(a) The Attorney General shall have the authority to investigate, institute proceedings, compromise and settle any investigation or action, and perform all duties in connection with any civil action to enforce G.S. 108A-70.12. (b) A civil action under G.S. 108A-70.12 may not be b…

(a) If the Attorney General has reasonable cause to believe that a person has information or is in possession, custody, or control of any document or other tangible object relevant to an investigation or that would lead to the discovery of relevant information in an investigation…

(a) In the absence of fraud or malice, no person who furnishes information to officials of the State responsible for investigating false claims violations shall be liable for damages in a civil action for any oral or written statement made or any other action that is necessary to…