Affordable Maternal Access & Cancer Care Act.

GENERAL ASSEMBLY OF NORTH CAROLINA
SESSION 2025
H 1
HOUSE BILL 1127

Short Title: Affordable Maternal Access & Cancer Care Act. (Public)
Sponsors: Representatives Belk, Clark, G. Brown, and Prather (Primary Sponsors).
For a complete list of sponsors, refer to the North Carolina General Assembly web site.
Referred to: Appropriations, if favorable, Rules, Calendar, and Operations of the House
April 30, 2026
*H1127-v-1*
A BILL TO BE ENTITLED 1
AN ACT ENACTING THE AFFORDABLE MATERNAL ACCESS AND CANCER CA RE 2
ACT TO ESTABLISH AND FUND A MATERNAL CARE ACCESS GRANT PROGRAM 3
AND A PROSTATE CANCE R CONTROL PROGRAM; A ND TO PROVIDE HEALTH 4
COVERAGE PARITY FOR SUPPLEMENTAL AND DIAGNOSTIC BREAST IMAGING. 5
Whereas, North Carolina continues to face preventable disparities in maternal health 6
outcomes, including higher rates of maternal mortality and severe maternal morbidity among 7
marginalized and underserved populations; and 8
Whereas, community -based, culturally respectful, evidence -based supports can 9
improve maternal health outcomes by addressing both clinical needs and social determinants of 10
health before, during, and after pregnancy; and 11
Whereas, uninsured and underinsured men with elevated prostate cancer risk often 12
face delayed screening and follow-up, resulting in later detection and worse outcomes; and 13
Whereas, patients should not face greater financial barriers to medically necessary 14
diagnostic or supplemental breast imaging than they face for screening mammography; and 15
Whereas, improving early detection, access to care, and continuity of care promotes 16
better health outcomes and advances the public interest in a healthier North Carolina; Now, 17
therefore, 18
The General Assembly of North Carolina enacts: 19
20
PART I. MATERNAL CARE ACCESS GRANT PROGRAM 21
SECTION 1.1.(a) Definitions. – The following definitions apply in this section: 22
(1) Culturally respectful congruent. – Sensitive to and respectful of the preferred 23
cultural values, beliefs, world view, and practices of the patient, and aware 24
that cultural differences between patients and health care providers or other 25
service providers must be proactively addressed to ensure that patients receive 26
equitable, high-quality services that meet their needs. 27
(2) Department. – The North Carolina Department of Health and Human 28
Services. 29
(3) Postpartum. – The one-year period beginning on the last day of a woman's 30
pregnancy. 31
SECTION 1.1.(b) Establishment of Grant Program. – The Department shall 32
establish and administer a Maternal Care Access Grant Program to award competitive grants to 33
eligible entities to establish or expand programs for the prevention of maternal mortality and 34
severe maternal morbidity among marginalized and underserved populations. T he Department 35
General Assembly Of North Carolina Session 2025
Page 2 House Bill 1127-First Edition
shall establish eligibility requirements for program participation which shall, at a minimum, 1
require that applicants be organizations led by individuals from communities that have 2
historically experienced disparities in accessing health and human services. 3
SECTION 1.1.(c) Outreach and Application Assistance. – Beginning July 1, 2026, 4
the Department shall (i) conduct outreach to encourage eligible applicants to apply for grants 5
under this program and (ii) provide application assistance to eligible applicants on best practices 6
for applying for grants under this program. In conducting the outreach required by this section, 7
the Department shall give special consideration to eligible applicants that meet the following 8
criteria: 9
(1) Are based in, and provide support for, communities with high rates of adverse 10
maternal health outcomes and significant racial and ethnic disparities in 11
maternal health outcomes. 12
(2) Are led by women from marginalized and underserved populations. 13
(3) Offer programs and resources that are aligned with evidence -based practices 14
for improving maternal health outcomes for marginalized and underserved 15
populations. 16
SECTION 1.1.(d) Grant Awards. – In awarding grants under this section, the 17
Department shall, to the extent possible , award grants to recipients to reflect different areas of 18
the State. The Department shall not award a single grant for less than ten thousand dollars 19
($10,000) or more than fifty thousand dollars ($50,000) per grant recipient. In selecting grant 20
recipients, the Department shall give special consideration to eligible applicants that meet all of 21
the following criteria: 22
(1) Meet all of the criteria specified in subdivisions (1) through (3) of subsection 23
(c) of this section. 24
(2) Offer programs and resources designed in consultation with and intended for 25
marginalized and underserved populations. 26
(3) Offer programs and resources in the communities in which they are located 27
that include any of the following activities: 28
a. Promoting maternal mental health and maternal substance use disorder 29
treatments that are aligned with evidence -based practices for 30
improving maternal mental health outcomes for marginalized and 31
underserved populations. 32
b. Addressing social determinants of health for women in the prenatal 33
and postpartum periods, including, but not limited to, any of the 34
following: 35
1. Inadequate housing. 36
2. Transportation barriers. 37
3. Poor nutrition and a lack of access to healthy foods. 38
4. Need for lactation support. 39
5. Need for lead abatement and other efforts to improve air and 40
water quality. 41
6. Lack of access to child care. 42
7. Need for baby supplies such as diapers, formula, clothing, baby 43
and child equipment, and safe car seat installation. 44
8. Need for wellness and stress management programs. 45
9. Education about maternal health and well-being. 46
10. Need for coordination across safety net and social support 47
services and programs. 48
11. Barriers to employment. 49
General Assembly Of North Carolina Session 2025
House Bill 1127-First Edition Page 3
c. Promoting evidence-based health literacy and pregnancy, childbirth, 1
and parenting education for women i n the prenatal and postpartum 2
periods, including group-based programs and peer support groups. 3
d. Providing individually tailored support from doulas and other perinatal 4
health workers to women from pregnancy through the postpartum 5
period. 6
e. Providing culturally respectful congruent training to perinatal health 7
workers such as doulas, community health workers, peer supporters, 8
certified lactation consultants, nutritionists and dietitians, social 9
workers, home visitors, and navigators. 10
f. Conducting or supporting research on issues affecting black maternal 11
health. 12
g. Developing other programs and resources that address 13
community-specific needs for women in the prenatal and postpartum 14
periods and are aligned with evidence -based practices for improving 15
maternal health outcomes for marginalized and underserved 16
populations. 17
SECTION 1.1.(e) Technical Assistance to Grant Recipients. – The Department shall 18
provide technical assistance to grant recipients regarding all of the following: 19
(1) Capacity building to establish or expand programs to prevent adverse maternal 20
health outcomes among marginalized and underserved populations. 21
(2) Best practices in data collection, measurement, evaluation, and reporting. 22
(3) Planning centered around sustaining programs implemented with grant funds 23
to prevent maternal mortality and severe maternal morbidity among 24
marginalized and underserved populations when the grant funds have been 25
expended. 26
SECTION 1.1.(f) There is appropriated from the General Fund to the Department of 27
Health a nd Human Services, Division of Public Health, the sum of five million dollars 28
($5,000,000) in recurring funds for the 2026-2027 fiscal year to be used and allocated as follows: 29
(1) Ninety-three thousand five hundred thirteen dollars ($93,513) in recurring 30
funds for the 2026-2027 fiscal year to establish a full-time, permanent Public 31
Health Program Coordinator IV position within the Department dedicated to 32
performing the following duties: 33
a. Providing application assistance to Maternal Care Access Grant 34
Program applicants. 35
b. Providing technical assistance to Maternal Care Access Grant Program 36
recipients. 37
c. Preparing the reports due under Section 1.1(h) of this Part. 38
(2) Four million nine hundred six thousand four hundred eighty -seven dollars 39
($4,906,487) in recurring funds for the 2026 -2027 fiscal year to be allocated 40
to the Maternal Care Access Grant Program authorized by this Part. The 41
Department may use up to one percent (1%) of these funds for administrative 42
purposes related to the grant program. The balance of these funds shall be used 43
to operate the grant program. 44
SECTION 1.1.(g) The Department is authorized to hire one full -time, permanent 45
Public Health Program Coordinator IV position to perform the duties described in subdivision 46
(f)(1) of this section. 47
SECTION 1.1.(h) Reports. – The Department shall submit the following reports on 48
the grant program authorized by this section to the Joint Legislative Oversight Committee on 49
Health and Human Services and the Fiscal Research Division: 50
General Assembly Of North Carolina Session 2025
Page 4 House Bill 1127-First Edition
(1) A report by October 1, 2027, that includes at least all of the following 1
components: 2
a. A detailed report on funds expended for the program for the 2026-2027 3
fiscal year. 4
b. An assessment of the effectiveness of outreach efforts by the 5
Department during the application process in diversifying the pool of 6
grant recipients. 7
c. Recommendations for future outreach efforts to diversify the pool of 8
grant recipients for this program and other related grant programs, as 9
well as for funding opportunities related to the socia l determinants of 10
maternal health. 11
(2) A report by October 1, 2028, that includes at least all of the following 12
components: 13
a. A detailed report on funds expended for the program for the 2027-2028 14
fiscal year. 15
b. An assessment of the effectiveness of progr ams funded by grants 16
awarded under this section in improving maternal health outcomes for 17
marginalized and underserved populations. 18
c. Recommendations for future grant programs to be administered by the 19
Department and for future funding opportunities for community-based 20
organizations to improve maternal health outcomes for marginalized 21
and underserved populations through programs and resources that are 22
aligned with evidence-based practices for improving maternal health 23
outcomes for marginalized and underserved populations. 24
25
PART II. PROSTATE CANCER CONTROL PROGRAM 26
SECTION 2.1. There is appropriated from the General Fund to the Department of 27
Health and Human Services, Division of Public Health, the sum of two million dollars 28
($2,000,000) in recurring funds f or the 2026 -2027 fiscal year to be used to establish and 29
administer a statewide Prostate Cancer Control Program that provides free or low -cost prostate 30
cancer screenings and follow -up to any man residing in North Carolina who meets all of the 31
following criteria: 32
(1) Is uninsured or underinsured. 33
(2) Is not a beneficiary of Medicare Part B or Medicaid. 34
(3) Is between 50 and 70 years of age and without a family history of prostate 35
cancer or is between 40 and 70 years of age with a family history of prostate 36
cancer. For the purpose of this subdivision, a man with a family history of 37
prostate cancer means any man with at least one first -degree relative who (i) 38
was diagnosed with prostate cancer, (ii) developed prostate cancer, (iii) died 39
as a result of prostate cancer, (iv) was diagnosed with a cancer known to be 40
associated with increased risk of prostate cancer, or (v) has a genetic alteration 41
known to be associated with increased risk of prostate cancer. 42
(4) Has a household income below two hundred fifty percen t (250%) of the 43
federal poverty level. 44
45
PART III. HEALTH INS URANCE REGULATION CH ANGES TO CREATE PARI TY 46
FOR SUPPLEMENTAL AND DIAGNOSTIC BREAST IMAGING 47
SECTION 3.1.(a) G.S. 58-51-57 is recodified as G.S. 58-3-271. 48
SECTION 3.1.(b) G.S. 58-65-92 is repealed. 49
SECTION 3.1.(c) G.S. 58-67-76 is repealed. 50
General Assembly Of North Carolina Session 2025
House Bill 1127-First Edition Page 5
SECTION 3.2. G.S. 58-3-271, as enacted by Section 3.1(a) of this act, reads as 1
rewritten: 2
"§ 58-3-271. Coverage for diagnostic, screening, and supplemental examinations for 3
breast cancer, including mammograms and other imaging, and cervical cancer 4
screening. 5
(a) The following definitions apply in this section: 6
(1) Breast magnetic resonance imaging. – A diagnostic tool that uses a powerful 7
magnetic field, radio waves, and a computer to produce detailed pictures of 8
the structures within the breast. 9
(2) Breast ultrasound. – A noninvasive diagnostic tool that uses high -frequency 10
sound waves to produce detailed images of the breast. 11
(3) Cost-sharing. – A deductible, coinsurance, copayment, and any maximum 12
limitation on the application of a deductible, coinsurance, copayment, or 13
similar out-of-pocket expense. 14
(4) Diagnostic examination for breast cancer. – An examination for breast cancer 15
that is determined by the healthcare provider treating the patient to be 16
medically necessary and appropriate and that may include breast magnetic 17
resonance imaging, breast ultrasound, and diagnostic low -dose 18
mammography to evaluate the abnormality in the breast that meets one of the 19
following criteria: 20
a. Is seen or suspected from a screening examination for breast cancer. 21
b. Is detected by another means of examination. 22
(5) High-deductible health plan. – As defined under the Internal Revenue Code. 23
(6) Low-dose mammography. – A radiologic procedure for the early detection of 24
breast cancer using equipment dedicated specifically for mammography, 25
including a physician's interpretation of the results of the procedure. 26
(7) Screening examination for breast cancer. – Low-dose mammography, or an 27
equivalent procedure, that is used to determine if there is abnorm ality in the 28
breast. 29
(8) Screening of early detection of cervical cancer. – Examinations and laboratory 30
tests used to detect cervical cancer, including conventional PAP smear 31
screening, liquid-based cytology, and human papilloma virus (HPV) detection 32
methods for women with equivocal findings on cervical cytologic analysis 33
that are subject to the approval of and have been approved by the United States 34
Food and Drug Administration. 35
(9) Section 223. – Section 223 of the Internal Revenue Code or its equivalent. 36
(10) Supplemental examination for breast cancer . – An examination for breast 37
cancer that is determined by the healthcare provider treating the patient to be 38
medically necessary and appropriate and that may include breast magnetic 39
resonance imaging or breast ultrasound to screen for cancer when there is no 40
abnormality seen or suspected if the patient meets either of the following 41
criteria: 42
a. The patient is at increased risk for breast cancer based on the patient's 43
personal medical history or family medical history of breast cancer. 44
b. The patient has a breast cancer risk profile that qualifies the patient 45
based on current recommendations of the United S tates Preventive 46
Services Task Force, also known as USPSTF. 47
(a)(a1) Every policy or contract of accident or health insurance, and every preferred provider 48
benefit plan under G.S. 58-50-56, that is issued, renewed, or amended on or after January 1, 1992, 49
health benefit plan offered by an insurer in this State shall provide coverage for examinations 50
and laboratory tests for the screening for the early detection of cervical cancer and for low-dose 51
General Assembly Of North Carolina Session 2025
Page 6 House Bill 1127-First Edition
screening mammography. The same deductibles, coinsurance, and other limitations as apply to 1
similar services covered under the policy, contract, or plan shall apply to coverage for 2
examinations and laboratory tests for the screening for the early detection of cervical cancer and 3
low-dose screening mammography. 4
(a1) As used in this section, "examinations and laboratory tests for the screening for the 5
early detection of cervical cancer" means conventional PAP smea r screening, liquid -based 6
cytology, and human papilloma virus (HPV) detection methods for women with equivocal 7
findings on cervical cytologic analysis that are subject to the approval of and have been approved 8
by the United States Food and Drug Administration. 9
(b) As used in this section, "low -dose screening mammography" means a radiologic 10
procedure for the early detection of breast cancer provided to an asymptomatic woman using 11
equipment dedicated specifically for mammography, including a physician's interpretation of the 12
results of the procedure. 13
(b1) Every health benefit plan offered by an insurer that provides benefits for a diagnostic 14
or supplemental examination for breast cancer shall ensure that the cost -sharing requirements 15
applicable to a diagnostic or supplemental examination for breast cancer are no less favorable 16
than the cost-sharing requirements applicable to low-dose screening mammography for breast 17
cancer. 18
(b2) An insurer shall not be required to reimburse a healthcare provider that is not a 19
contracted provider in the provider network of a health benefit plan offered by the insurer any 20
reimbursement rate more than the rate paid to a provider that has contracted with the insurer to 21
participate in the provider network of the health benefit plan for any of the following services: 22
(1) Diagnostic, screening, or supplemental examination for breast cancer. 23
(2) Low-dose mammography. 24
(3) Breast ultrasound. 25
(4) Breast magnetic resonance imaging. 26
(c) Coverage for low-dose screening mammography shall be provided as follows: 27
(1) One or more mammograms a year, as recommended by a physician, for any 28
woman who is at risk for breast cancer. For purposes of this subdivision, a 29
woman is at risk for breast cancer if any one or more of the following is true: 30
a. The woman has a personal history of breast cancer;cancer. 31
b. The woman has a personal history of biopsy -proven benign breast 32
disease;disease. 33
c. The woman's mother, sister, or daughter has or has had breast cancer; 34
orcancer. 35
d. The woman has not given birth prior to the age of 30;30. 36
(2) One baseline mammogram for any woman 35 through 39 years of age, 37
inclusive;inclusive. 38
(3) A mammogram every other year for any woman 40 through 49 years of age, 39
inclusive, or more frequently upon recommendation of a physician; 40
andphysician. 41
(4) A mammogram every year for any woman 50 years of age or older. 42
(d) Reimbursement for a mammogram authorized under this section shall be made only 43
if the facility in which the mammogram was performed meets mammography accreditation 44
standards established by the North Carolina Medical Care Commission. 45
(e) Coverage for the screening for the early detection of cervical cancer shall be in 46
accordance with the most recently published American Cancer Society American College of 47
Obstetricians and Gynecologists ' guidelines or guidelines adopted by the North Carolina 48
Advisory Committee on Cancer Coordination and Contr ol. Coverage shall include the 49
examination, the laboratory fee, and the physician's interpretation of the laboratory results. 50
General Assembly Of North Carolina Session 2025
House Bill 1127-First Edition Page 7
Reimbursements for laboratory fees shall be made only if the laboratory meets accreditation 1
standards adopted by the North Carolina Medical Care Commission. 2
(f) If the application of any provision of this section would render the insured ineligible 3
for a health savings account under section 223 , then that provision shall apply only for 4
high-deductible health plans with respect to the deductible of that plan after the insured has 5
satisfied the minimum deductible under section 223, except with respect to items or services that 6
are preventive care . For items or services that are preventive care under section 223, all 7
provisions of this section shall apply regardless of whether or not the minimum deductible under 8
section 223 has been satisfied." 9
SECTION 3.3.(a) G.S. 135-48.51 reads as rewritten: 10
"§ 135-48.51. Coverage and operational mandates related to Chapter 58 of the General 11
Statutes. 12
The following provisions of Chapter 58 of the General Statutes apply to the State Health Plan: 13
… 14
(9a) G.S. 58-3-271, Coverage for diagnostic, screening, and supplemental 15
examinations for breast cancer, including mammograms and other imaging, 16
and cervical cancer screening. 17
…." 18
SECTION 3.3.(b) Effective July 1, 2026, there is appropriated from the General 19
Fund to the Department of State Treasurer the sum of five million dollars ($5,000,000) in 20
recurring funds for the 2026 -2027 fiscal y ear to ensure compliance with subsection (a) of this 21
section by the North Carolina State Health Plan for Teachers and State Employees. 22
SECTION 3.4. Except as otherwise provided, this Part becomes effective October 23
1, 2026, and applies to insurance contracts issued, renewed, or amended on or after that date. 24
25
PART IV. HEALTHCARE PROVIDER BILLING REG ULATION CHANGES TO 26
CREATE PARITY FOR SU PPLEMENTAL AND DIAGN OSTIC BREAST CANCER 27
IMAGING 28
SECTION 4.1.(a) G.S. 90-701 is recodified as G.S. 90-705. 29
SECTION 4.1.(b) Article 41 of Chapter 90 of the General Statutes, as amended by 30
subsection (a) of this section, reads as rewritten: 31
"Article 41. 32
"Pathology Services Billing.Transparency in Healthcare Provider Billing Practices. 33
"§ 90-702. Definitions. 34
The following definitions shall apply in this Article: 35
(1) Breast cancer prevention service. – All services listed under 36
G.S. 58-3-271(b2). 37
(2) Cost-sharing. – As defined in G.S. 58-3-271. 38
(3) Reserved for future codification purposes. 39
(4) Health benefit plan. – As defined in G.S. 58-3-167. 40
(5) Health services facility. – A facility that is licensed under (i) Chapter 131E or 41
Chapter 122C of the General Statutes or (ii) the licensing laws of another state 42
for the provision of the same services in the ordinary co urse of business or 43
practice as would require the facility to be licensed under Chapter 131E or 44
Chapter 122C of the General Statutes were the facility located in this State. 45
(6) Healthcare provider. – A health services facility or a person who is licensed, 46
registered, or certified under Chapter 90 or Chapter 90B of the General 47
Statutes, or under the laws of another state, to provide healthcare services in 48
the ordinary care of business or practice, or as a profession, or in an approved 49
education or training program. 50
(7) Reserved for future codification purposes. 51
General Assembly Of North Carolina Session 2025
Page 8 House Bill 1127-First Edition
(8) Insurer. – As defined in G.S. 58-3-167. 1
"§ 90-704. Billing for certain breast cancer prevention services. 2
(a) A healthcare provider who has not contracted with an insurer to participate in the 3
provider network of a health benefit plan shall accept as reimbursement for any breast cancer 4
prevention service provided to an individual insured under a health benefit plan the amount of 5
reimbursement provided by that insure r, including any cost-sharing required to be paid by the 6
patient. 7
(b) No healthcare provider may bill a patient covered under a health benefit plan or 8
request additional reimbursement from the insurer for any amount above the amount required to 9
be accepted under subsection (a) of this section. 10
…." 11
SECTION 4.2. This Part is effective October 1, 2026, and applies to services 12
provided on or after that date. 13
14
PART V. EFFECTIVE DATE 15
SECTION 5.1. Except as otherwise provided, this act becomes effective July 1, 16
2026. 17