Protecting Medicaid & Autism Services.

GENERAL ASSEMBLY OF NORTH CAROLINA
SESSION 2025
H 1
HOUSE BILL 1141

Short Title: Protecting Medicaid & Autism Services. (Public)
Sponsors: Representatives Crawford, Prather, Hawkins, and G. Pierce (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
May 4, 2026
*H1141-v-1*
A BILL TO BE ENTITLED 1
AN ACT TO ALLOW MEDI CAID PREPAID HEALTH PLANS TO OPERATE A C LOSED 2
PROVIDER NETWORK FOR RESEARCH-BASED BEHA VIORAL HEALTH 3
TREATMENT PROVIDERS, TO PROVIDE FUNDING FOR THE MEDICAID REBASE, 4
AND TO ELIMINATE THE STATUTORY TRIGGERS FOR DISCONTINUATION OF 5
COVERAGE FOR THE MEDICAID EXPANSION POPULATION. 6
Whereas, the State must periodically rebase Medicaid appropriations to reflect 7
changes in enrollment, service utilization, capitation costs, federal match rates, and program 8
design; and 9
Whereas, maintaining adequate Medicaid funding is necessary to preserve access to 10
care for children, families, older adults, and people with disabilities across North Carolina; and 11
Whereas, research -based behavioral health treatment should be delivered throug h 12
provider arrangements that promote quality, accountability, and reliable patient access; and 13
Whereas, continuity of coverage is essential to the health and financial stability of 14
North Carolinians enrolled in Medicaid expansion; and 15
Whereas, eliminating statutory coverage -discontinuation triggers and providing 16
sufficient program funding will strengthen the stability and effectiveness of North Carolina's 17
Medicaid program; Now, therefore, 18
The General Assembly of North Carolina enacts: 19
20
MEDICAID REBASE FUNDING 21
SECTION 1.(a) There is appropriated from the General Fund to the Department of 22
Health and Human Services, Division of Health Benefits, the sum of three hundred nineteen 23
million dollars ($319,000,000) in recurring funds and associated receipts, beg inning with the 24
2025-2026 fiscal year, and an additional sum of seven hundred twenty -eight million dollars 25
($728,000,000) in recurring funds and associated receipts, beginning with the 2026 -2027 fiscal 26
year. These funds shall be used to adjust Medicaid fun ding to account for projected changes in 27
enrollment, enrollment mix, service and capitation costs, and federal match rates, as well as the 28
implementation of the Children and Families Specialty Plan in December 2025. 29
SECTION 1.(b) This section is retroactively effective July 1, 2025. 30
31
CLOSED PROVIDER NETWORK FOR RESEARCH-BASED BEHAVIORAL HEALTH 32
TREATMENT PROVIDERS 33
SECTION 2.(a) G.S. 108D-22 reads as rewritten: 34
"§ 108D-22. PHP provider networks. 35
General Assembly Of North Carolina Session 2025
Page 2 House Bill 1141-First Edition
(a) Except as provided in G.S. 108D-23 and G.S. 108D-24, each PHP shall develop and 1
maintain a provider network that meets access to care requirements for its enrollees. A PHP may 2
not exclude providers a provider from their networks the PHP's network except for failure (i) if 3
the provider fails to meet objective qua lity standards standards, or refusal (ii) if the provider 4
refuses to accept network rates. rates, or (iii) in accordance with subsection (c) of this section. 5
Notwithstanding the previous sentence, a PHP must include all providers in its geographical 6
coverage area that are designated essential providers by the Department in accordance with 7
subdivision (b) of this section, unless the Department approves an alternative arrangement for 8
securing the types of services offered by the essential providers. 9
… 10
(c) Each PHP shall develop and maintain a closed network of providers applicable only 11
to the provision of research-based behavioral health treatment services." 12
SECTION 2.(b) G.S. 108D-24 reads as rewritten: 13
"§ 108D-24. Children and families specialty plan networks. 14
(a) The entity operating the children and families specialty plan shall develop and 15
maintain a closed network of providers only as provided in this section. 16
(b) The requirement to operate a closed network is applicable only to the provision of the 17
following services: 18
(1) Intensive in-home services. 19
(2) Multisystemic therapy. 20
(3) Residential treatment services. 21
(4) Services provided in psychiatric residential treatment facilities. 22
(5) Research-based behavioral health treatment services. 23
…." 24
SECTION 2.(c) G.S. 108D-35 reads as rewritten: 25
"§ 108D-35. Services covered by PHPs. 26
(a) Capitated PHP contracts shall cover all Medicaid services, including physical health 27
services, prescription drugs, long -term services and supports, and behavioral he alth services, 28
except as otherwise provided in this section. 29
(b) The capitated contracts required by this section shall not cover any of the following: 30
(1) Medicaid services covered by the local management entities/managed care 31
organizations (LME/MCOs) und er the combined 1915(b) and (c) waivers, 32
1915(b)(3) services, and any services approved under the 1915(i) option shall 33
not be covered under a standard benefit plan, except that all capitated PHP 34
contracts shall cover the following services: 35
… 36
l. Research-based intensive behavioral health treatment. 37
…." 38
39
ELIMINATION OF STATUTORY TRIGGERS FOR DISCONTINUATION OF 40
COVERAGE FOR THE MEDICAID EXPANSION POPULATION 41
SECTION 3.(a) G.S. 108A-54.3B is repealed. 42
SECTION 3.(b) G.S. 108A-54.3C is repealed. 43
44
EFFECTIVE DATE 45
SECTION 4. Except as otherwise provided, this act is effective when it becomes 46
law. 47