Part I includes seven legislative findings related to long-term care of older adults.

Part II.

Enacts GS 108A-70.5A establishing state policy for individuals 55 or older to receive long-term services and supports funded by medical assistance programs in the most integrated setting appropriate to their needs. Creates a presumption of preference for home- and community-based services for purposes of Medicaid-funded long-term care services and supports unless institutional placement is medically unnecessary. Requires documentation that home- and community-based services are insufficient to meet clinical, functional, or safety needs to be placed or remain in an institutional long-term care setting. Details required assessment and documentation. Specifies that the statute does not limit an individual's right to choose an institutional setting if eligible and informed of available home- and community-based service options. Grants the Department of Health and Human Services (DHHS) implementing and rulemaking authority.

Enacts GS 108A-70.5B to require DHHS to ensure periodic medication review for individuals aged 55 or older receiving Medicaid-funded long-term services and supports. Incudes legislative findings and states the purpose of the reviews are to reduce preventable harm and unnecessary health expenditures. Lists four parameters of the medication reviews, including considering the cumulative medication burden drug-drug interactions, and drug-condition interactions. Requires the reviews be conducted by a licensed pharmacist, physician, or other qualified health care professional authorized by DHHS and acting within their scope of licensure. Authorizes DHHS to adopt rules to permit deprescribing and medication modification when clinically appropriate. Require medication review findings to be incorporated into the patient's care plan. Allows DHHS to implement review requirements through managed care contracts, clinical policy, or other administrative mechanisms and prioritize implementation based on highest risk of medication-related harm. 

Enacts GS 108A-70.5C to require DHHS to ensure that behavioral health assessment, treatment, and care coordination are integrated into the delivery of Medicaid-funded long-term services and supports for adults aged 55 or older. States the purpose of the statute is to ensure access to services to improve quality of life, reduce hospitalizations, and decrease reliance on inappropriate sedation or chemical restraint. Lists five parameters for behavioral health integration, including crisis intervention strategies that reduce emergency department visits and hospitalizations. Requires DHHS to promote care models and clinical practices that prioritize nonpharmacological and person-centered interventions and discourage the use of antipsychotics, sedatives, or other medications that are not clinically indicated. Authorizes DHHS to implement the requirements through clinical policy, managed care contracts, provider standards, care management requirements, or other administrative mechanisms and prioritize implementation based on highest risk of behavioral health-related hospitalization or institutional placement. Authorizes DHHS to support training and technical assistance for providers and care managers related to geriatric behavioral health and dementia-capable care expertise.

Enacts GS 108A-70.5D to direct DHHS to authorize and promote screening for social isolation and loneliness among adults aged 55 or older receiving Medicaid-funded long-term services and supports using evidence-based tools approved by DHHS. States the purpose of the statute is to prevent avoidable health decline, functional impairment, and progression to more serious mental health conditions. Provides three permissible actions that may follow screening, including care coordination, referrals, and service decision making. Requires social isolation and loneliness identified through screening to be grounds for Medicaid-funded care coordination, assessment, and referral services. Specifies these conditions do not require coverage of nonmedical housing nor substitute clinical evaluations. Authorizes DHHS to implement the requirements through clinical policy, care management requirements, managed care contracts, or other administrative mechanisms and prioritize implementation based on higher risk of hospitalization, functional decline, or institutional placement.

Part III.

Directs DHHS to establish and conduct an integrated senior housing and care pilot program (program). States the purpose of the program and lists four criteria that must be met for DHHS and any selected partner entity to launch the pilot facility, including that residents retain tenancy rights and receive health and supportive services through integrated on-site or affiliated providers. Grants DHHS four authorities with regard to the program, including establishing a selection process for contracts, structuring the program as a public-private partnership, coordinating state and federal support, and adopting necessary rules. Appropriates $120 million from the General Fund to DHHS for 2026-27 to establish and conduct the program. Lists four permissible uses of the funds and specifies that the fund remain available until expended. Directs DHHS to annually report to the specified NCGA committee and division by May 1, 2028, until funds are expended, on the implementation and operation of the program. Specified required content. Terminates the program at the end of the fiscal year in which appropriated funds are expended.

Directs the Office of the State Long-Term Care Ombudsman to strengthen the State Long-Term Care Ombudsman Program (LTC Program) in four specific ways including reducing the backlog of complaints received by the LTC Program. Directs the office to develop and implement a staffing and regional coverage plan for the LTC Program by January 1, 2027, that meets five benchmarks, including supporting complaint intake, investigation, resolution, and follow-up. Appropriates $3.5 million in recurring funds from the General Fund to the Office to improve the LTC program and implement the staffing and regional coverage plan. Lists seven permissible uses of appropriated funds. Directs the Office to annually report to the specified NCGA committee and division on the status of implementation beginning December 1, 2027. Specified required content.

Enacts GS 143B-181.87 to direct DHHS to establish a geriatric workforce pipeline and direct care career advancement program (advancement program). Requires consultation with specified agencies and licensing boards. States the advancement program's purpose is to increase the supply, distribution, retention, and advancement of workers prepared to serve older adults in a variety of settings. Lists seven benchmarks for the advancement program including implementing recruitment initiatives targets to rural counties, underserved communities, and areas experiencing workforce shortages in the geriatric and long-term care settings. Authorizes funding loan forgiveness and similar initiatives for eligible individuals committing to practice in these settings in the State for a minimum period of time set by DHHS. Details required priority for workforce investments. Requires recognition of credentials developed under the advancement program across participating employers and training institutions to the extent practicable. Directs DHHS to annually report to the specified NCGA committees and division on implementation and operation of the advancement program. Specified required content.

Appropriates $10 million in recurring funds from the General Fund to DHHS for implementation of the geriatric workforce pipeline and advancement program.

Directs DHHS, Division of Health Benefits (DHB) to take action to support implementation of the pilot program for eligible caregivers of Medicaid beneficiaries receiving long-term services and supports as specified. States the purpose of the pilot program is to authorize a Medicaid-funded family caregiver support stipend to reduce caregiver burnout, delay or prevent avoidable institutionalization, and support older adults in home- and community-based settings. Directs DHB to implement the pilot program subject to federal approval. Caps the monthly stipend at $400 to each eligible family caregiver per eligible care recipient. Directs DHB to adopt rules or clinical coverage policies to establish (1) eligibility criteria for recipients and family caregivers that include at least four listed criteria, including that the family caregiver satisfies any training, documentation, and program integrity requirements; and (2) guardrails for the program that can include six listed options, such as safeguards to protect beneficiary choice, health, safety, and quality of care. Directs DHB to report to the specified NCGA committee and division within six months of federal approval and annually thereafter. Specifies required content. Clarifies no entitlement to a stipend exists without federal approval and legislative appropriation. Appropriates $13.5 million in recurring funds and $750,000 in nonrecurring funds from the General Fund for 2026-27 to DHB for implementation of the pilot program. Specifies that unexpended funds revert. Sunsets the directives two years from the date the act becomes law.

Creates the Aging Study Commission (Commission) to study and recommend legislative changes necessary for the State's response to the needs of the aging population. Lists eight issues the Commission must address, including financing and sustainability of services for older adults and oversight, quality, and accountability in long-term care settings. Identifies Commission membership and appointment. Includes 15 voting members, with 12 legislatively appointed and three gubernatorially appointed, and five ex officio members. Provides for Commission meetings and staffing. Directs the Commission to report to the NCGA by December 31, 2027. Terminates the Commission upon submission of the report.

Effective July 1, 2026.