The North Carolina House and Senate each gave final approval Tuesday to House Bill 696, a measure that fills a $319 million funding gap for Medicaid. The bill now goes to Gov. Josh Stein, who has not said whether he intends to sign it.
“Fully funding Medicaid is critical to protecting health care for millions of North Carolinians. Our office is reviewing the bill,” a spokesperson for Stein told NC Local.
If the bill becomes law, it will provide funds for health insurance for 3.1 million low-income individuals, children and some people with disabilities.
State health officials remain concerned that even with immediate relief, new rules required by the “One Big Beautiful Bill” could kick hundreds of thousands out of the program.
What does this mean for Medicaid coverage?
Funding the program
Stein’s administration – namely the state Department of Health and Human Services – has been pushing for lawmakers to close the Medicaid shortfall, but without a broader state budget, the funding only lasts through the end of this fiscal year on June 30.
The measure passed Tuesday avoids any disruptions in coverage until then, but lawmakers must pass a full budget or continue funding at the previous year’s levels to keep the program stable.
“We are working on budget assessments for future years and do not have comment on those projections at this time,” a DHHS spokeswoman told NC Local.
Work requirements
Meanwhile, the bill includes new “community engagement” rules – or work requirements – mandated by H.R. 1, or the “One Big Beautiful Bill.”
If you’re between 19 and 64 and are able to work, you will be required to log 80 hours per month of work or “qualifying activities” to stay on Medicaid.
DHHS has said that can include going to school, volunteering in your community, or participating in a work training program. You will have to log these hours with your county Department of Social Services each month.
Federal law gives states the option to check beneficiaries’ work status on a one-, two-, or three-month lookback period for beneficiaries who were part of North Carolina’s Medicaid expansion in 2023.
The bill passed Tuesday implements the three-month option. That means those beneficiaries would have to meet work requirements for three consecutive months before they can apply for Medicaid.
More than 720,000 North Carolinians have now gained access to Medicaid since North Carolina expanded the program under the Affordable Care Act in 2023.
“This change will reduce access to Medicaid expansion eligibility, particularly for those transitioning between jobs or starting new employment,” the DHHS spokeswoman said.
Eligibility checks
House Bill 696 requires the state Department of Health and Human Services to review beneficiaries’ eligibility for Medicaid every month instead of every three months, a rule that some local officials worry will require more staff and cost counties more money.
Under the bill, Medicaid recipients would not be able to qualify solely based on information they report themselves. In most cases, the state would need more proof of eligibility requirements, such as income, how many people live in the beneficiary’s household, or work status.
What do supporters and opponents of the bill say?
The state health department says H.R. 1’s rules puts people’s coverage at risk.
“As many as 255,000 NC Medicaid expansion beneficiaries could lose coverage beginning in January 2027,” the DHHS spokeswoman told NC Local. New eligibility checks would go into effect on October 1. New work requirements would go into effect January 1, 2027.
Opponents, like Democratic state Rep. Pricey Harrison of Guilford County, also objected to the bill’s new limits on Medicaid coverage for non-citizens, a provision that she argued effectively eliminates access to health care for 27,000 women and children who are in the country legally, but are not yet American citizens.
Still, it passed with overwhelming bipartisan support by votes of 112-3 in the House and 45-3 in the Senate. The bill’s sponsors say time is running out to shore up the Medicaid funding gap before the end of the fiscal year, and they worry if the state does not start complying with H.R. 1’s new rules, they could lose federal funding for Medicaid.
State Rep. Larry Potts, a Republican from Davidson County and a primary sponsor of the bill, said that concern “hasn’t fallen on deaf ears,” indicating the legislature will likely pass more adjustments to Medicaid funding in the short session, which is expected to continue into July.
Gov. Stein has 10 days to determine whether to sign the bill into law.
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