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H491 • 2025

Medicaid Rebase Funding.

Medicaid Rebase Funding.

Enacted

This bill passed the Legislature and reached final enactment based on the latest official action.

Sponsor
Lambeth, Rhyne, White, Dixon, Arp, Balkcom, Biggs, Blackwell, Blust, Cairns, Campbell, Huneycutt, Johnson, McNeely, Moss, Penny, Pyrtle, Scott, Strickland, Ward, Willis, Winslow
Last action
2025-10-23
Official status
Held by House Clerk
Effective date
Not listed

Plain English Breakdown

Using official source text because the generated explanation was unavailable or could not be confirmed against the official bill text.

Medicaid Rebase Funding.

H491-SMTR-3(e1)-v-5 (2025-04-01): Medicaid Work Requirements.

What This Bill Does

  • H491-SMTR-3(e1)-v-5 (2025-04-01): Medicaid Work Requirements.
  • H491-SMTR-46(CSTRa-7)-v-3 (2025-10-21): Medicaid Rebase Funding.

Limits and Unknowns

  • This entry is temporarily using official source text because the generated explanation could not be confirmed against the official bill text during the last sync.

Amendments

These notes stay tied to the official amendment files and metadata from the legislature.

Filed

Plain English: 2025-2026 General Assembly HOUSE BILL 491: Medicaid Work Requirements.

  • 2025-2026 General Assembly HOUSE BILL 491: Medicaid Work Requirements.
  • Committee: House Health.
  • If favorable, re -refer to Rules, Calendar, and Operations of the House Date: April 1, 2025 Introduced by: Reps.
  • Lambeth, Rhyne, White, Dixon Prepared by: Jennifer Hillman Staff Attorney Analysis of: First Edition Kara McCraw Director *H491-SMTR-3(e1)-v-5* Legislative Analysis Division 919-733-2578 This bill analysis was prepared by the nonpartisan legislative staff for the use of legislators in their deliberations and does not constitute an official statement of legislative intent.
Filed

Plain English: 2025-2026 General Assembly HOUSE BILL 491: Medicaid Rebase Funding.

  • 2025-2026 General Assembly HOUSE BILL 491: Medicaid Rebase Funding.
  • Committee: House Rules, Calendar, and Operations of the House Date: October 17, 2025 Introduced by: Reps.
  • Lambeth, Rhyne, White, Dixon Prepared by: Alison Rossi Jennifer Hillman Staff Attorneys Analysis of: PCS to First Edition H491-CSTRa-7 Kara McCraw Director *H491-SMTR-46(CSTRa-7)-v-3* Legislative Analysis Division 919-733-2578 This bill analysis was prepared by the nonpartisan legislative staff for the use of legislators in their deliberations and does not constitute an official statement of legislative intent.
  • OVERVIEW: The PCS to H491 would provide additional funding for continued operations of the Medicaid program by (1) appropriating $190 million from the Medicaid Contingency Reserv e and (2) repeating a directive for local management entity/managed care organizations (LME/MCOs) to make specified intergovernmental transfers.

Bill History

  1. 2025-10-23 House

    Held by House Clerk

  2. 2025-10-23 House

    Message Refused by Senate

  3. 2025-10-23 Senate

    Not received; ineligible pursuant to Res. 2025-11

  4. 2025-10-23 House

    Regular Message Sent To Senate

  5. 2025-10-22 House

    Passed 3rd Reading

  6. 2025-10-22 House

    Passed 2nd Reading

  7. 2025-10-21 House

    Placed On Cal For 10/22/2025

  8. 2025-10-21 House

    Cal Pursuant Rule 36(b)

  9. 2025-10-21 House

    Reptd Fav Com Substitute

  10. 2025-04-01 House

    Re-ref Com On Rules, Calendar, and Operations of the House

  11. 2025-04-01 House

    Reptd Fav

  12. 2025-03-25 House

    Ref to the Com on Health, if favorable, Rules, Calendar, and Operations of the House

  13. 2025-03-25 House

    Passed 1st Reading

  14. 2025-03-24 House

    Filed

Official Summary Text

H491-SMTR-3(e1)-v-5
(2025-04-01): Medicaid Work Requirements.
H491-SMTR-46(CSTRa-7)-v-3
(2025-10-21): Medicaid Rebase Funding.

Current Bill Text

Read the full stored bill text 
GENERAL ASSEMBLY OF NORTH CAROLINA
SESSION 2025
H 2
HOUSE BILL 491
Committee Substitute Favorable 10/21/25

Short Title: Medicaid Rebase Funding. (Public)
Sponsors:
Referred to:
March 25, 2025
*H491-v-2*
A BILL TO BE ENTITLED 1
AN ACT TO FUND THE MEDICAID REBASE. 2
The General Assembly of North Carolina enacts: 3
4
MEDICAID REBASE FUNDING 5
SECTION 1. Notwithstanding the limitations under G.S. 143C-4-11 on the use, 6
allocation, and expenditure of funds reserved in the Medicaid Contingency Reserve, there is 7
appropriated from the Medicaid Contingency Reserve to the Department of Health and Human 8
Services, Division of Health Benefits, the sum of one hundred ninety million dollars 9
($190,000,000) in nonrecurring funds and associated receipts for the 2025-2026 fiscal year to be 10
used to adjust Medicaid funding to account for projected changes in enrollment, enrollment mix, 11
service and capitation costs, and federal match rates, as well as the implementation of the 12
Children and Families Specialty Plan in December 2025. 13
14
LME/MCO INTERGOVERNMENTAL TRANSFERS 15
SECTION 2.(a) The local management entities/managed care organizations 16
(LME/MCOs) shall make intergovernmental transfers to the Department of Health and Human 17
Services, Div ision of Health Benefits (DHB), in an aggregate amount of eighteen million 18
twenty-eight thousand two hundred seventeen dollars ($18,028,217) in the 2025-2026 fiscal year 19
and in an aggregate amount of eighteen million twenty -eight thousand two hundred seven teen 20
dollars ($18,028,217) for the 2026 -2027 fiscal year. The due date and frequency of the 21
intergovernmental transfer required by this section shall be determined by DHB. The amount of 22
the intergovernmental transfer that each individual LME/MCO is required to make in each fiscal 23
year shall be as follows: 24
2025-2026 2026-2027 25
Alliance Behavioral Healthcare $4,508,857 $4,508,857 26
Partners Health Management $3,544,348 $3,544,348 27
Trillium Health Resources $6,448,693 $6,448,693 28
Vaya Health $3,526,319 $3,526,319 29
SECTION 2.(b) In the event that a county disengages from an LME/MCO and 30
realigns with another LME/MCO during the 2025 -2027 fiscal biennium, DHB shall have the 31
authority to reallocate the amount of the intergovernmental transfer that each affected 32
LME/MCO is required to make under subsection (a) of this section, taking into consideration the 33
change in catchment area and covered population, provided that the aggregate amount of the 34
transfers received from all LME/MCOs in each year of the fiscal biennium is achieved. 35
36
General Assembly Of North Carolina Session 2025
Page 2 House Bill 491-Second Edition
EFFECTIVE DATE 1
SECTION 3. Except as otherwise provided, this act is effective retroactively to July 2
1, 2025. 3