Amends GS 131E-18 to increase the permissive range of the number of commissioners for county hospital authority boards, now requiring at least eight (was six) and not more than 38 (was 30) commissioners. Adds a new requirement for membership to include (1) four public members who are not licensed healthcare providers, married to licensed healthcare providers, employed by the authority, or married to anyone employed by the authority; and (2) four elected officials who are either county commissioners or city/town officials in a municipality located within the hospital authority's territorial boundaries, as specified. Authorizes adoption of a resolution to increase or decrease the number of commissioners by fixed number upon finding that it is required for statutory compliance. Adds a new requirement that any meeting of the Commissioners must be conducted in accordance with state public meetings laws, GS Chapter 143, Article 33C.

Specifies that an authority that already meets membership requirements for public or elected official commissioners required by GS 131E-18 is not required to appoint additional commissioners. Provides for staggering the appointment of public and elected official members by initial members serving one and two years terms, with all subsequent terms being three years. Requires appointments be made to comply with the act by December 1, 2026. 

Appropriates $50,000 from the General Fund to the Department of Health and Human Services for 2026-27 to ensure hospital authorities are in compliance with the act.