Bill Summaries: H 5 CLOSE THE MEDICAID COVERAGE GAP.

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  • Summary date: Jan 30 2019 - More information

    Section 1

    Repeals Section 3 of SL 2013-5, which prohibited any State entity from expanding Medicaid eligibility as provided in PL 111-148 (the Affordable Care Act) and SL 2011-145.

    Section 2

    Enacts GS 108A-54.3B, providing criteria under which individuals are considered part of the Medicaid coverage gap and are eligible for Medicaid benefits through an Alternative Benefit Plan established by the Department of Health and Human Services (DHHS), unless the individual is exempt from mandatory enrollment in an Alternative Benefit Plan under 42 CFR 440.315. Eligibility is based on income, age, and ineligibility for enrollment in described Medicaid coverage. Mandates that co-payments for benefits provided under the Alternative Benefit Plan must be the same as those required for Medicaid beneficiaries not under the Alternative Benefit Plan.

    Directs DHHS to provide coverage to individuals eligible under new GS 108A-54.3B, consistent with SL 2015-245, as amended (Medicaid Transformation and Reorganization).

    The above provisions are effective on the date that capitated coverage begins as required under SL 2015-245, as amended. 

    Section 3

    Specifies the intent of the General Assembly to enact legislation during the 2019 Regular Session to replace the Hospital Provider Assessment Act (Article 7, GS Chapter 108A) with a similar hospital provider assessment that will impose an assessment to pay for the State share of the program and administrative costs associated with Medicaid expansion.

     


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