House amendments to the 1st edition make the following changes.

Amendment #1 adds the requirement that if there is any indication that work requirements as a condition of participation in the Medicaid program may be authorized by the Centers for Medicare and Medicaid Services (CMS), then the Department of Health and Human Services, Division of Health Benefits (DHB), must negotiate with CMS to develop a plan for those work requirements and to obtain approval of that plan. Requires DHB, within 30 days of entering into negotiations with CMS, to provide written notification to the specified NCGA committee and division of the negotiations. Requires DHB to report to those same entities, within 30 days of approval by CMS of a plan for work requirements as a condition of participation in the Medicaid program, on the details of the approved work requirements, including the approved date of implementation of the requirements.

Amendment #2 appropriates $50 million for 2023-24 from the General Fund to the DHB to be distributed to all counties for the administrative costs of Medicaid eligibility determinations and for inmate medical costs. Effective the later of July 1, 2023, or the date the Current Operations Appropriations Act for the 2023-24 fiscal year becomes law.

Requires funds to be distributed on a per capita basis, with each county receiving at least $100,000. Specifies that the provisions of GS 143C-5-2 (Order of appropriations bills) do not apply to this act.

Amendment #3 adds the following. Establishes the Doctors and Nurses in Rural Areas Forgivable Loan Pilot Program to be administered by the State Education Assistance Authority (Authority) to provide forgivable loans to eligible students who agree to practice medicine or nursing on a full-time basis in a rural area (an NC county designated by the NC Rural Center as a rural county). Defines an eligible student as either of the following types of students enrolled in an eligible postsecondary institution (as defined) in the 2024-25 academic year as a first-year student in a program of study approved by the Authority for students to receive funds under the Forgivable Education Loans for Service Program related to the following degrees: (1) a student enrolled in a medical school for purposes of becoming a licensed physician or (2) a student enrolled in an associate, bachelor, masters, or doctoral degree program in nursing for purposes of becoming a licensed nurse.

Requires the Authority to establish the criteria for initial and continuing eligibility for participation in the program, including at least: (1) requiring loan recipients to be NC residents attending an eligible postsecondary institution; (2) standards necessary to ensure only qualified persons receive a loan, including priority for applicants from rural areas; and (3) to the extent funds provided pursuant to this section are insufficient to award forgivable loans to all interested, eligible students, the Authority may establish a lottery process to select recipients.

Requires promissory notes have an interest rate established by the Authority that does not exceed 10% and is in relation to the current interest rate for non-need-based federal loans made pursuant to Title IV of the Higher Education Act of 1965, as amended. Sets out the loan amounts, with amounts varying for degrees in Doctor of Medicine, Doctor in Nursing, Masters in Nursing, Bachelor in Nursing, and Associate in Nursing. Requires forgiving loans based on the amount received by the eligible student for each year that the recipient works as a licensed physician or nurse practicing on a full-time basis in a rural area, up to the total amount initially awarded to the recipient. Requires the Authority to establish any other necessary criteria for loan forgiveness for qualifying employment. Requires the Authority to collect cash repayments when service repayment is not completed.

Requires the Authority to report annually while loans are held or forgiven by the Authority, beginning by December 1, 2024, to the specified NCGA committees on the program and loans that are awarded, including specified information on the forgivable loans awarded by the Authority, placement and repayment rates, and on recommendations to expand the program and increase the number of licensed physicians and nurses practicing in rural areas.

Appropriates $14.4 million for 2023-24 from the General Fund to the UNC Board of Governors to be allocated to the Authority to provide forgivable loans to an estimated 200 eligible students in accordance with the program. Requires the funds to remain available until expended. Allows the Authority to use up to $200,000 of the funds for administrative costs.

Effective the later of July 1, 2023, or the date the Current Operations Appropriations Act for the 2023-24 fiscal year becomes law.

Specifies that the provisions of GS 143C-5-2 (Order of appropriations bills) do not apply to this act.