Section 1.

Contains whereas clauses. Titles the act “The Thrive at Midlife Act.”  

Section 2.

Defines essential midlife healthcare services to include seven services, including menopause-related care and hormone therapy, mammograms and cervical cancer screenings, cardiovascular disease prevention, diabetes screenings and management, and telehealth services for midlife-specific conditions. Defines midlife women as individuals assigned female at birth or who identify as women and who are at least 40 but less than 65 years of age.

Section 3.

Enacts GS 58-3-305 requiring all health benefit plans to include coverage for essential midlife services for midlife women. Directs that any cost-sharing requirements, including copayments and deductibles, for essential midlife healthcare services must not exceed those established for preventative services under the Patient Protection and Affordable Care Act (PL 111-148) or other federal law. Effective October 1, 2025, and applies to insurance contracts issued, renewed, or amended on or after that date. Requires the Department of Health and Human Services (DHHS), Division of Health Benefits (DHB) to ensure the coverage described.

Effective July 1, 2025, appropriates $10 million from the General Fund to DHHS’s Division of Central Management and Support, Office of Rural Health (ORH) in recurring funds for each year of the 2025-27 fiscal biennium to establish a Midlife Health Access Grant Program (Program) to provide directed grants on a competitive basis to federally qualified health centers, rural health clinics, community-based nonprofit organizations, and other safety-net providers that are capable of providing essential midlife healthcare services to midlife women who are uninsured regardless of their ability to pay. Provides for an application to be developed by ORH. Requires ORH to give priority to grant applicants located in rural and underserved areas of the State and to cap the grant award at $100,000 per grantee. Authorizes ORH to use up to 5% of the allocated fund for administrative costs in establishing and administering the Program. Requires an annual report by ORH on the Program to the specified NCGA committee and the Fiscal Research Division (FRD), due April 1 and to start on April 1, 2027.

Section 4.

Enacts GS 105-153.12, a midlife healthcare individual tax credit, as follows. Defines five terms, including out-of-pocket expenses (total of the following expenses that are not reimbursed by health insurance: expenses for midlife healthcare (defined), expenses for menopause treatment (defined), and expenses for prescription medications (defined)).  Specifies that a taxpayer who has out-of-pocket expenses is allowed a credit against the individual income tax equal to a percentage of the taxpayer's ranging from 100% of out-of-pocket expenses to 0% of those expenses based on the taxpayer’s filing status and adjusted gross income.  Specifies that if the credit allowed by GS 105-153.12 exceeds the amount of individual income tax imposed for the taxable year reduced by the sum of all credits allowable, requires the Secretary of Revenue (Secretary) to refund the excess to the taxpayer, as described.

Enacts GS 105-153.13, establishing a midlife healthcare business tax credit, for a taxpayer who is an eligible business (defined) and has out-of-pocket expenses (defined) against the income tax imposed equal to 10% of their total out-of-pocket expenses. Specifies that if the credit allowed by GS 105-153.13 exceeds the amount of income tax imposed for the taxable year reduced by the sum of all credits allowable, requires the Secretary to refund the excess to the taxpayer, as described. Limits the total amount of credits allowed pursuant to GS 105-153.13 to $5 million in the aggregate for all taxpayers for any one calendar year. Requires an eligible business to apply for the tax.  Requires applications to be accepted on a first come, first served basis. Requires the Department of Revenue (DOR) to submit an annual report to the specified NCGA committee by March 31 of each year on the tax credit, including the matters described.

Effective for taxes imposed for taxable years beginning on or after January 1, 2025.

Creates the Thrive at Midlife Grant Program (GP) to be administered by DHHS.  Defines eight terms, including eligible businesses (a business with a physical presence in the State that (1) has its headquarters located in this State, (2) employs 50 or fewer people in this State, (3) has out-of-pocket expenses during the taxable year in which it applies for grant funding under this section, and (iv) submits proof of its out-of-pocket expenses on a form and in a manner approved by the DHHS). Allows eligible businesses to apply DHHS for a grant under the GP, as described. Directs grants to be awarded on a first come, first served basis not to exceed $2,500 per year.  Limits the total of all awarded grants to the total amount of the appropriated funds and available under GP. Requires DHHS to verify that an applicant is an eligible business prior to awarding any funds under GP.  Appropriates $1 million from the General Fund to DHHS for the 2025-26 year to be used for the GP. Authorizes DHHS to use up to 3% of expenses for administrative purposes. Allows DHHS, in conjunction with DOR, to conduct random audits.  Effective July 1, 2025.

Section 5.

Expands the powers and duties of the UNC Board of Governors in GS 116-11 to require each UNC school of medicine to separately establish a midlife health fellowship program meeting the described criteria. Requires each UNC school of medicine to establish a midlife health fellowship program by July 1, 2026.

Amends Section 9B.7A(b) of SL 2023-143 so that the ORH’s telehealth infrastructure grant program includes independent practices that provide essential midlife healthcare services to individuals assigned female at birth or who identify as women and who are at least 40 but less than 65 years of age as one of the rural healthcare services to be given priority under the program. Effective July 1, 2025.

Requires ORH to establish and administer a Regional Midlife Health Hubs Pilot Program (Pilot Program) by October 1, 2025 to evaluate the effectiveness of utilizing a community hub accessible in person, through the World Wide Web, or through any other means of electronic access, to refer midlife women to community-based, essential midlife healthcare services. Places the Pilot Program in the five North Carolina counties with the highest healthcare disparities among midlife women. Requires each participating county to establish a Regional Midlife Health Hub (Hub) responsible for implementing and administering the Pilot Program on behalf of the residents of that county. Effective July 1, 2025, appropriates $2.625 million from the General Fund to ORH for each year of the 2025-27 biennium to fund the Pilot Program, and to be allocated equally amongst the Hubs. Allows each Hub to use up to 5% of its allocated funds for each year of the 2025-27 biennium to pay for administrative costs as specified.  Requires DHHS to conduct a comprehensive evaluation of the Pilot Program and submit a report of its findings, including the four specified matters to the specified NCGA committee and the FRD by February 1, 2028. Sunsets the Pilot Program upon the submission of the report.

Section 6.

Effective July 1, 2025, appropriates $500,000 from the General Fund to DHHS for each year of the 2025-27 biennium to launch a statewide educational and public awareness campaign as described on health challenges for midlife women and available resources and services to address these challenges.

Effective July 1, 2025, appropriates $2 million from the General Fund to DHHS for each year of the 2025-27 biennium to provide grants on a competitive basis to local, nonprofit, and faith-based organizations that partner with DHHS to conduct culturally competent outreach and education about health challenges for midlife women and available resources and services to address these challenges. Requires ORH to annually report to the specified NCGA committee and the FRD on the use of such funds including the three listed matter, due on April 1, 2027 and April 1, 2028, respectively.

Section 7.

Annually by February 1, beginning February 1, 2027, requires DHHS to compile an annual Midlife Health Report identifying gaps in health insurance coverage for essential midlife healthcare services and evaluating healthcare  disparities among midlife women residing in the State, to be submitted to the specified NCGA committee, the FRD, and made publicly available on DHHS’s website. Enacts GS 130A-33.45 establishing the nine-member Midlife Health Advisory Council (Council) in DHHS, tasked with five duties, including to identify and examine the limitations and problems associated with existing laws, regulations, programs, and services related to the health status of midlife women and to identify and review health promotion and disease prevention strategies relating to the leading causes of death and disability among midlife women.  Provides for membership appointment, a chair, quorum, clerical support and other services from DHHS, and expenses reimbursement in GS 130A-33.46.

Appropriates $250,000 in recurring funds for each year of the 2025-27 biennium from the General Fund to DHHS for the Council's expenses.

Section 8.

Contains a severability clause.