The Ciji Graham Act.

GENERAL ASSEMBLY OF NORTH CAROLINA
SESSION 2025
H 1
HOUSE BILL 1172

Short Title: The Ciji Graham Act. (Public)
Sponsors: Representatives Johnson-Hostler, Greenfield, and Clark (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
*H1172-v-1*
A BILL TO BE ENTITLED 1
AN ACT TO IMPROVE MATERNAL HEALTH OUTCOMES AND REDUCE MATERNAL 2
HEALTH DISPARITIES IN NORTH CAROLINA THR OUGH THE ESTABLISHMENT 3
OF A HIGH -RISK PREGNANCY CARE NAVIGATION PROGRAM, A PREGNANC Y 4
CONSULTATION HOTLINE , A CENTRALIZED CLIN ICAL INFORMATION HUB 5
FOR MANAGING HIGH -RISK PREGNANCIES, AND STANDARDIZED REFERRAL 6
PATHWAYS FOR HIGH-RISK PREGNANCIES; AND TO APPROPRIATE FUNDS TO 7
THE DEPARTMENT OF HE ALTH AND HUMAN SERVI CES, DIVISION OF PUB LIC 8
HEALTH, FOR THESE PURPOSES. 9
Whereas, the untimely death of Ciji Graham – a beloved mother, daughter, and friend 10
– highlights the devastating intersection of medical risk, delayed treatment, and restrictive 11
healthcare policies; and 12
Whereas, current policy created an unfortunate situation in which Ciji Grah am's 13
serious underlying illness, the hesitancy of physicians due to restrictive laws, and policy -driven 14
delays prevented timely, coordinated care when minutes and days mattered; and 15
Whereas, maternal health outcomes in North Carolina remain a significant p ublic 16
health concern, particularly among Black women and rural populations; and 17
Whereas, there is an urgent need to bolster North Carolina's healthcare system to 18
ensure access to timely and accurate information, resources, and care for high -risk pregnancies; 19
Now, therefore, 20
The General Assembly of North Carolina enacts: 21
22
PART I. TITLE 23
SECTION 1.1. This act shall be known as "The Ciji Graham Act." 24
25
PART II. HIGH-RISK PREGNANCY CARE NAVIGATION PROGRAM 26
SECTION 2.1.(a) There is appropriated from the General Fund to the Department 27
of Health and Human Services, Division of Public Health, the sum of two million three hundred 28
thousand dollars ($2,300,000) in recurring funds beginning in the 2026 -2027 fiscal year to 29
establish a uniform High-Risk Pregnancy Care Navigation Program (the program) in each of the 30
six North Carolina Medicaid managed care regions to support the use of licensed nurses as care 31
navigators to assist individuals experiencing high -risk pregnancies with ac cessing timely, 32
equitable, and clinically appropriate care. These funds shall be allocated and used as follows: 33
(1) One million three hundred thousand dollars ($1,300,000) to establish 12 34
full-time, permanent Nurse Consultant positions within the Departmen t of 35
General Assembly Of North Carolina Session 2025
Page 2 House Bill 1172-First Edition
Health and Human Services, Division of Public Health, to be distributed 1
equally among the six North Carolina Medicaid managed care regions. Each 2
Nurse Consultant position funded by this section shall be dedicated to 3
performing the following duties wit hin the program, either in person or 4
through the use of telehealth services, defined as the use of two-way, real-time 5
interactive audio and video where the nurse consultant and the pregnant 6
patient can hear and see each other: 7
a. Assisting patients in unde rstanding diagnoses associated with 8
high-risk pregnancy conditions. 9
b. Coordinating timely referrals to appropriate providers, including (i) 10
maternal-fetal medicine specialists and high -risk obstetricians, (ii) 11
hospital systems equipped for high -risk labor and delivery, and (iii) 12
providers offering pregnancy termination services, when clinically 13
indicated and consistent with patient choice and State law. 14
c. Providing culturally competent, patient -centered guidance that 15
respects patient autonomy and informed decision making. 16
d. Addressing barriers to care, including transportation, insurance 17
enrollment, appointment scheduling, and continuity of care. 18
(2) One million dollars ($1,000,000) to cover the cost of program administration 19
and to purchase equipment, hi gh-speed internet access, and any other 20
infrastructure necessary to establish telehealth services. The Department of 21
Health and Human Services, Division of Public Health, may use up to one 22
percent (1%) of these funds for administrative purposes related to the 23
program. 24
SECTION 2.1.(b) Annually by September 1, beginning September 1, 2028, the 25
Department of Health and Human Services, Division of Public Health, shall report to the Joint 26
Legislative Oversight Committee on Health and Human Services and the Fisca l Research 27
Division on the establishment and operation of the High -Risk Pregnancy Care Navigation 28
Program authorized and funded by subsection (a) of this section. The report shall include at least 29
all of the following: 30
(1) An itemized list of program expenditures. 31
(2) A description of the care navigation services provided under the program, 32
including the utilization frequency of these services. 33
(3) An evaluation of the timeliness of referrals provided under the program and 34
the impact on patient access to care. 35
(4) An evaluation of the impact of the program on maternal and infant health 36
outcomes associated with high-risk pregnancies. 37
(5) Any obstacles to effective program operation and recommendations for 38
program improvement. 39
40
PART III. PREGNANCY CONSULTATION HOTLINE 41
SECTION 3.1.(a) There is appropriated from the General Fund to the Department 42
of Health and Human Services, Division of Public Health, the sum of seven million seven 43
hundred thousand dollars ($7,700,000) in recurring funds beginning in the 2026-2027 fiscal year 44
to establish a statewide hotline that provides free, real-time telephone consultation to healthcare 45
providers serving pregnant patients and community -based organizations focused on caring for 46
pregnant women. The hotline shall be staffed Mon day through Friday from 8:00 A.M. to 5:00 47
P.M. with qualified healthcare providers capable of doing all of the following: 48
(1) Providing rapid access to clinical guidance from qualified specialists, 49
including maternal-fetal medicine specialists. 50
(2) Offering immediate case-specific clinical guidance. 51
General Assembly Of North Carolina Session 2025
House Bill 1172-First Edition Page 3
(3) Supporting urgent and emergent decision making. 1
(4) Providing referrals to all of the following: 2
a. North Carolina's Pregnancy Medical Home Program. 3
b. Maternal health services. 4
c. Nutritional assistance pro grams, including the Women, Infants, and 5
Children (WIC) Program and the Food and Nutrition Services 6
Program. 7
d. Community-based organizations that can serve as a resource to both 8
healthcare providers and pregnant patients. 9
SECTION 3.1.(b) No later than Se ptember 1, 2027, and September 1, 2028, the 10
Department of Health and Human Services, Division of Public Health, shall submit to the Joint 11
Legislative Oversight Committee on Health and Human Services and the Fiscal Research 12
Division the following informatio n regarding the hotline established pursuant to subsection (a) 13
of this section: 14
(1) The number of consultations provided over the previous fiscal year. 15
(2) The geographic regions of the State utilizing the services offered by the 16
hotline. 17
(3) The percentag e of hotline consultations that resulted in referral to a 18
maternal-fetal medicine specialist. 19
(4) The estimated number of avoided emergency department visits resulting from 20
the services provided through the hotline. 21
(5) Any other information the Department of Health and Human Services, 22
Division of Public Health, deems relevant to successful operation of the 23
hotline. 24
25
PART IV. CENTRALIZED CLINICAL INFORMATIO N HUB FOR MANAGING 26
HIGH-RISK PREGNANCIES 27
SECTION 4.1. The Department of Health and Human Services sha ll develop and 28
maintain a centralized, evidence-based digital information hub for clinicians managing patients 29
with high-risk pregnancies that includes all of the following: 30
(1) Up-to-date clinical guidelines for managing high-risk pregnancy conditions. 31
(2) A real-time, regionally organized directory of: 32
a. Maternal-fetal medicine specialists. 33
b. High-risk obstetric providers. 34
c. Facilities equipped for complex pregnancy care. 35
d. Providers of abortion care services, to the extent permitted by State 36
law. 37
(3) Standardized referral protocols to support timely and appropriate care 38
transitions. 39
(4) Decision-support tools to assist clinicians in counseling and referral for 40
patients with complex or life-threatening conditions during pregnancy. 41
42
PART V. STANDARDIZED REFERRAL PATHWAYS F OR HIGH -RISK 43
PREGNANCIES 44
SECTION 5.1. The Department of Health and Human Services, in consultation with 45
relevant stakeholders, shall establish uniform referral pathways to ensure that patients diagnosed 46
with high-risk pregnancy conditions are offered either of the following: 47
(1) For those seeking to continue their pregnancies, immediate referral to 48
appropriate high-risk obstetric or maternal-fetal medicine care. 49
General Assembly Of North Carolina Session 2025
Page 4 House Bill 1172-First Edition
(2) For those electing not to continue their pregnancies or when terminatio n of 1
pregnancy is medically indicated, timely referral to qualified providers for 2
pregnancy termination services to the extent permitted by State law. 3
4
PART VI. EFFECTIVE DATE 5
SECTION 6.1. This act becomes effective July 1, 2026. 6