Amends Section 1.8, SL 2023-7, as amended, extending authority of the Department of Health and Human Services (DHHS) to use the federally facilitated Marketplace to make Medicaid eligibility determinations on a temporary basis to now conclude by June 30, 2028 (was, June 30, 2025). Requires eligibility determinations be made in compliance with GS 108A-54(f) (was, subsection (b)).

Amends GS 108A-40 relating to the categories of Medicaid program aid that are not required to be covered by capitated PHP (primary health plan) contracts. Regarding the exception for inmate recipients, and recipients residing in carceral settings other than prison whose Medicaid eligibility has been suspended, provides that the exception continues until the first day of the month following the twelfth month after the recipient's release (was, the shorter of either the recipient's initial Medicaid eligibility certification period post release or 365 days). Applies to inmates released on or after the date the act becomes law and inmates released on or after January 1, 2025, who are not enrolled with a PHP on the date the act becomes law.

Amends GS 108C-3 relating to Medicaid provider screening. Effective retroactively to January 1, 2023, specifies that nursing facilities categorized as "limited" risk do not include skilled nursing facilities, whereas prospective (newly enrolling) skilled nursing facilities and those undergoing a change in ownership are designated as "high" risk, and revalidating skilled nursing facilities are "moderate" risk unless the facility meets the description for "high" risk designation.

Further amends GS 108C-3 as follows. Moves portable X-ray suppliers from "low" categorical risk to "moderate." Designates prospective (newly enrolling) hospice organizations and those undergoing a change in ownership as "high" risk. Designates as "high" categorical risk the following revalidating providers that are revalidating for the first time since newly enrolling and for which fingerprinting requirements as a newly enrolling provider were waived due to a national, State, or local emergency: opioid treatment programs that have not been fully and continuously certified by the Substance Abuse and Mental Health Services Administration since October 23, 2018; agencies providing durable medical equipment; adult care homes delivering Medicaid-reimbursed services; agencies providing private-duty, home health, personal care services, in-home care services, or home infusion; skilled nursing facilities; and hospice organizations. Designates other revalidating hospice organizations which do not meet the description for those designated "high" risk as "moderate." Makes conforming changes. Effective retroactively to January 1, 2024.

Amends GS 108A-57 relating to the State's subrogation rights to medical beneficiary Medicaid claims. Adds new language authorizing DHHS to designate one or more PHPs to receive all or a portion of payments due under the section to DHHS for a Medicaid claim by sending a notice of designation to the beneficiary who has the claim against the third party and any PHP designated in the notice. Defines "designated PHP" as used in the section to refer to a PHP designated in this notice. Adds that if a PHP made payments on behalf of a Medicaid beneficiary that are in the Medicaid claim, that the beneficiary's application to a court to dispute the presumptions established by subsection (a1) of the section must be served on that PHP within the same time frame as service required on DHHS by current law. Includes non-payment and payment to a designated PHP, as an alternative to DHHS, within the required determinations of a court regarding a beneficiary who disputes the section's presumption. Requires notification of any designated PHP of the receipt of proceeds of a settlement or judgment related to a Medicaid claim by the beneficiary, and includes designated PHPs as an alternative to DHHS for specified distribution of the proceeds. Applies to Medicaid claims brought by medical assistance beneficiaries against third parties on or after the date the act becomes law.