Includes whereas clauses.

Part I.

Repeals Section 3, SL 2013-5, which bars the State from expanding the State's Medicaid eligibility under the Medicaid expansion provided in the Affordable Care Act, PL 111-148, as amended, for which the enforcement was ruled unconstitutional by the U.S. Supreme Court, and bars State entities from attempting to expand the Medicaid eligibility standards provided in SL 2011-145, as amended, or elsewhere in State law, unless directed by the NCGA. Effective January 1, 2024, amends GS 108A-54.3A to enact new subdivision (24), requiring the Department of Health and Human Services (DHHS) to provide Medicaid coverage to individuals described in section 1902(a)(10)(A)(i)(VIII) of the Social Security Act. Section 1902(a)(10)(A)(i)(VIII) of the Social Security Act includes individuals who, beginning January 1, 2014, are under 65 years of age, not pregnant, not entitled to, or enrolled for, benefits under part A of title XVIII, or enrolled for benefits under part B of title XVIII, and are not described in a another subclause, and whose income does not exceed 133% of the poverty line applicable to a family of the size involved. Makes coverage available through an Alternative Benefit Plan established by DHHS consistent with federal requirements, unless the individual is exempt from mandatory enrollment in the Plan under 42 CFR 440.315. 

Requires DHHS to establish preventive care and wellness incentives for individuals eligible for Medicaid coverage under the provisions described in amended GS 108A-54.3A. Specifies the types of care and activities that the incentives are to cover. Requires DHHS to consider the methods and types of incentives used by other states for this population. Encourages prepaid health plans to offer preventive care and wellness incentives to their enrollees.

Requires DHHS and all county departments of social services to begin accepting applications from, and enrolling if permissible, individuals who will be eligible for coverage under amended GS 108A-54.3A as soon as practicable but no later than December 1, 2023.

Enacts GS 108A-54.3B. States legislative intent to fully fund the nonfederal share of the cost of NC Health Works, meaning the provision of Medicaid coverage to the individuals described in new GS 108A-54.3A(24), through a combination of (1) increases in revenue from the gross premium tax due to NC Health Works; (2) increases in intergovernmental transfers due to NC Health Works, excluding any State retention; (3) the hospital health assessment under Part 3, Article 7B, GS Chapter 108A, excluding State retention; and (4) savings to the State attributable to the NC Health Works corresponding to General Fund budget reductions to other State programs. Directs DHHS to annually report, beginning in 2025, to the specified NCGA committee, division, and the Office of State Budget and Management (OSBM), as specified. Requires expeditiously discontinuing coverage for the individuals described in new GS 108A-54.3A(24) if the nonfederal share of the cost cannot be fully funded through the described sources. Requires the DHHS Secretary to notify the specified NCGA committee, division, and OSBM of such a determination, and post notice to its website including the proposed effective date of the discontinuation of coverage. Also requires the DHHS Secretary to submit necessary documentation to the Centers for Medicare and Medicaid Services (CMS). Enacts GS 108A-54.3C to require expeditious discontinuation of Medicaid coverage if the federal medical assistance percentage for Medicaid coverage provided to the individuals described in new GS 108A-54.3A(24) falls below 90%. Requires the DHHS Secretary to fulfill identical requirements as those for a discontinuation due to insufficient funds from identified sources in GS 108A-54.3B. Effective January 1, 2024.

Establishes the ARPA Temporary Savings Fund as a nonreverting special fund in the Division of Health Benefits (DHB) consisting of any savings realized as a result of federal receipts arising from the enhanced federal medical assistance percentage (FMAP) available to the State under section 9814 of the American Rescue Plan Act (ARPA). Requires legislative allocation or expenditure of the funds. Expires 10 years after the date this act becomes law.

Enacts new Part 4, Healthcare Access and Stabilization Program, in Article 7B (Hospital Assessment Act) of GS Chapter 108A, providing as follows. Provides that the healthcare access and stabilization program (HASP) is a directed payment program that provides acute care hospitals with increased reimbursements funded through assessments. Requires DHHS to submit a specified preprint requesting approval for the HASP program that includes any required demonstration for the financing of the nonfederal share of the HASP program costs; prohibits DHHS from making any HASP-directed payments before CMS approval of the initial preprinting. Prohibits DHHS from requesting any date of service for claims eligible for reimbursement through the HASP program earlier than July 1, 2022. Requires DHHS to continue to submit any necessary documentation requesting continued approval for the HASP program in the time and manner required by CMS. Requires the state funds required to make HASP directed payments to be derived from HASP components of the hospital assessments under Article 7B subject to the specified limitations. Prohibits DHHS, as a part of the preprint submission for the 2022-23 State fiscal year, from requesting any amount of HASP hospital reimbursements that is (1) greater than the maximum allowable under the specified federal provision or (2) less than an annual estimated total dollar amount of $3.2 billion for services provided to not newly eligible individuals.

Provides that for the State fiscal quarter beginning October 1, 2023, each acute care hospital, except for critical access hospitals, is subject to an assessment of a percentage of its hospital costs. Requires DHHS to impose this assessment in accordance with the procedures for hospital assessments under Part 1 of Article 7B of GS Chapter 108A. Requires DHHS to calculate the hospital assessment percentage by dividing $12.8 million by the total hospital costs for all acute care hospitals except for critical access hospitals. Requires DHHS to use $4 million from the assessment proceeds to provide funding to county departments of social services to support the counties in preparing to implement Section 1.1 of this act (repealing Section 3 of SL 2013-5 and enacting GS 108A-54.3A(24). This provision expires December 31, 2023.

Requires DHHS, by March 1, 2024, to report to the specified NCGA committee and division on the amount of the proceeds from the assessment that DHHS provided to each county department of social services and the date that those proceeds were provided to each county department of social services.

Amends GS 108A-145.3, which sets out the definitions for terms as they are used in Article 7B, to add and define actual nonfederal expenditures, consumer price index: all urban consumers, consumer price index: medical care, current quarter, FMAP for newly eligible individuals, HASP directed payments, healthcare access and stabilization program (HASP), IGT, newly eligible individual, nonfederal share for newly eligible individuals, and nonfederal share for not newly eligible individuals.

Enacts new Part 3, Health Advancement Assessments, in Article 7B of GS Chapter 108A, providing as follows. Effective January 1, 2024. Makes the public hospital health advancement assessments imposed under this Part applicable to all public acute care hospitals. Requires the assessment to be assessed as a percentage of each public acute care hospital's hospital costs, with the percentage calculated quarterly. Requires the percentage for each quarter to equal the aggregate health advancement assessment collection amount calculated under new GS 108A-147.3 multiplied by the public hospital historical assessment share and divided by the total hospital costs for all public acute care hospitals holding a license on the first day of the assessment quarter. Makes the private hospital health advancement assessment imposed under this Part applicable to all private acute care hospitals. Requires the assessment to be assessed as a percentage of each private acute care hospital's hospital costs, with the percentage calculated quarterly. Requires the percentage for each quarter to equal the aggregate health advancement assessment collection amount calculated under new GS 108A-147.3 multiplied by the private hospital historical assessment share and divided by the total hospital costs for all private acute care hospitals holding a license on the first day of the assessment quarter.

Sets out provisions detailing the process for calculating the aggregate health advancement assessment collection amount. Provides that the aggregate health advancement assessment collection amount is an amount of money calculated quarterly by adjusting the total nonfederal receipts for health advancement calculated under the statute by (1) subtracting the health advancement presumptive IGT adjustment component calculated under the specified new statute, (2) adding the positive or negative health advancement IGT actual receipts adjustment component calculated under the specified new statute, and (3) subtracting the positive or negative IGT share of the reconciliation adjustment component calculated under the specified new statute. Provides that the total nonfederal receipts for health advancement is an amount of money calculated quarterly by adding all of the following: (1) the presumptive service cost component calculated under the specified new statute; (2) the HASP health advancement component calculated under the specified new statute; (3) the administration component calculated under the specified new statute; (4) the State retention component under the specified new statute; and (5) the positive or negative health advancement reconciliation adjustment component calculated under the specified new statute. Sets out the statutes detailing these components.

Requires in new GS 108A-147.13, except as provided below, the proceeds of the health advancement assessments imposed under this Part, and all corresponding matching federal funds, to be used only to fund: (1) medicaid actual nonfederal expenditures for newly eligible individuals, including HASP directed payments; (2) administrative expenditures for newly eligible individuals; and (3) administrative expenditures related to the HASP program. Requires DHHS to use an amount of the proceeds of the health advancement assessments that is equal to the county administration subcomponent of the administration component to provide funding to county departments of social services to support the counties in determining eligibility for newly eligible individuals. Limits the amount of the proceeds of the health advancement assessments that may be used for administrative expenses attributable to providing Medicaid coverage to newly eligible individuals and administrative expenditures associated with the HASP program, to an amount equal to the sum of the State administration subcomponent of the administration component for each quarter of the State fiscal year, and all corresponding matching federal funds. Requires DHHS to use an amount from the proceeds of the health advancement assessments equal to the State retention component and all corresponding matching federal funds, for Medicaid program costs.

Enacts new GS 143C-9-10 establishing the Health Advancement Receipts Special Fund (Fund) established as a nonreverting special fund in DHHS. Requires DHHS, each fiscal quarter, to deposit in the Fund funds equal to the total nonfederal receipts for health advancement for that quarter, minus the State retention component for that quarter, and plus the positive or negative gross premiums tax offset amount for that quarter. Requires DHHS to use the funds in the Fund only for purposes described in GS 108A-147.13. Effective January 1, 2024.

States the NCGA’s intent to appropriate recurring funds to DHHS, Division of Health Benefits, equaling the total of the gross premiums tax offset amount.

Amends new GS 108A-147.7 by increasing the amount of the State administration subcomponent for each quarter of the 2023-24 fiscal year. Effective upon the later of: (1) the first day of the next assessment quarter after the CMS approves the initial 42 C.F.R. § 438.6(c) preprint requesting approval of the healthcare access and stabilization program (HASP) submitted in accordance with GS 108A-148.1 or (2) January 1, 2024. Applies to assessments imposed on or after the effective date.

Requires the Secretary of the Department of Health and Human Services to notify the Fiscal Research Division and the Revisor of Statutes of the date that CMS approves of the initial 42 C.F.R. § 438.6(c) preprint requesting approval of the HASP program  submitted in accordance with GS 108A-148.1, as enacted by this act. Provides that if, by June 30, 2025, the Department of Health and Human Services has not received approval of that preprint, then subsection (e) of this section (which further amends GS 108A-147.7) expires on that date.

Amends the following statutes in Part 2, Modernized Hospital Assessments, of Article 7B.

Refers to the hospital assessments as the hospital modernized assessment in the following: GS 108A-146.1, GS 108A-146.3, and GS 108A-146.5.

Amends GS 108A-146.5 to amend the calculation of the aggregate modernized assessment collection amount to now be the amount of money calculated by subtracting the modernized intergovernmental transfer adjustment component from the total modernized nonfederal receipts and then adding the positive or negative amount of the modernized IGT actual receipts adjustment component. Amends the components of the modernized nonfederal receipts to include the modernized HASP component. Enacts new GS 108A-146.10 setting out the calculation of the modernized HASP component. Enacts new GS 108A-146.14 setting out the process for calculating the modernized IGT actual receipts adjustment component.

Amends the following components of the calculation of the aggregate modernized assessment collection amount. Amends GS 108A-146.7 to amend the managed care component, amends GS 108A-146.9 by amending the fee-for service component, and amends GS 108A-146.11 by amending the graduate medical education component. Deletes the existing provisions of GS 108A-146.13 which sets out the calculation of the intergovernmental transfer adjustment component and replaces it with the calculation of the modernized presumptive IGT adjustment component.

Amends GS 108A-146.15 by expanding upon the allowable uses of the process of the assessment and corresponding matching federal funds, to include HASP-directed payments attributable to hospital reimbursements for not newly eligible individuals.

Effective January 1, 2024, amends GS 108A-146.12 by amending the amount of the postpartum coverage component for the specified quarters of the 2023-24 fiscal year.

Amends Section 2.1 of SL 2021-61, effective January 1, 2024. Provides that for any quarter in which the State receives the temporary increase of Medicaid FMAP (federal medical assistance percentage) allowed under (1) section 6008 of the Families First Coronavirus Response Act or (2) section 9814 of the American Rescue Plan Act of 2021, the FMAP for purposes of Article 7B of GS Chapter 108A shall be the federal share of North Carolina Medicaid service costs as calculated by the federal Department of Health and Human Services in accordance with section 1905(b) of the Social Security Act in effect at the start of the applicable assessment quarter, plus the applicable temporary increase, expressed as a decimal.

Repeals the following sections of SL 2021-180: (1) Section 9D.13A(e), which set, for the assessment quarter that begins on April 1, 2024, the home and community-based services component at $40,350,000 and the home and community-based services subcomponent at $9,563,000; (2) Section 9D.14, which made changes concerning allowing a parent to retain medicaid eligibility while a child is temporarily served by the foster care system. Effective January 1, 2024.

Amends GS 108D-65(6)a to refer to the report prepared by the Office of the Actuary instead of the Office of the Actuary for nonexpansion states. Effective January 1, 2024.

Part II.

Requires the Secretary of Commerce, by December 1, 2024, to develop a plan to create a seamless, statewide, comprehensive workforce development program, bringing together new opportunities with the current workforce development opportunities within the Department of Commerce, Department of Labor, and other State agencies. Requires the plan to be developed in collaboration with the 13 named stakeholders. Allows contracting with third-party entities in the development and implementation of the plan. Requires the Secretary to strive to ensure that all workforce development opportunities are available to participants statewide by coordinating efforts and resources across State agencies. Specifies five components of the plan. Requires the Secretary of Commerce, by December 1, 2024, to report to the specified NCGA committees on the plan. Specifies items that must be included in the report.

Requires the Department of Commerce to collaborate with DHHS in developing a method by which to assist individuals enrolled in the North Carolina Medicaid program and other relevant social service programs with accessing appropriate workforce development services. Requires DHHS to develop a plan for assessing the current employment status and any barriers to employment of newly enrolled Medicaid beneficiaries and newly enrolled participants in other relevant social service programs. Requires DHHS and Commerce to determine the best method by which Medicaid beneficiaries and beneficiaries of other relevant social service programs will be provided an initial assessment and consultation with a workforce development case manager, or other similar professional, to ensure that interested individuals can participate in the state’s workforce development programs. Allows contracting with third-party entities or prepaid health plans to assist in providing these services and allows consideration of the use of incentives to prepaid health plans with regard to these services. Requires DHHS by December 1, 2024, to report to the specified NCGA committee on the method determined to be best to provide the required initial assessment and consultation with a workforce development case manager, or other similar professional. Specifies items to be included in the report. Requires DHHS and Commerce, beginning February 1, 2025, and for five years thereafter, to report annually to the specified NCGA committees on specified information related to those Medicaid beneficiaries and participants in other relevant social service programs and their participation in workforce development services and programs.

Sets out the NCGA’s finding that awareness of, and assistance with, enrollment in health benefit coverage on the federal Health Insurance Marketplace will alleviate the false perception that the loss of Medicaid coverage equals an immediate loss of access to healthcare. Requires DHHS, Division of Health Benefits (DHB), to work with the NC Navigators Consortium to develop a mechanism by which a Medicaid recipient who is transitioning from qualifying for the Medicaid program to qualifying for premium or cost-sharing assistance for health insurance obtained on the Health Insurance Marketplace, or who could reasonably be determined to be eligible, will be assisted with that transition by a qualified Navigator or similar professional. Requires, at a minimum, that by January 1, 2024, DHB provide all Medicaid applicants written notification about the Health Insurance Marketplace that includes the NC Navigators Consortium’s contact information. Requires the notification to also be provided to all Medicaid recipients, with the stated exceptions. Requires DHB to report by March 1, 2024, to the specified NCGA committee on details of the mechanism that has been developed for providing assistance, and details on the required written notification.

Part III.

Provides that the act is effective on the date that the Current Operations Appropriations Act for the 2023-2024 fiscal year becomes law. If, by December 31, 2023, no Current Operations Appropriations Act for the 2023-2024 fiscal year has become law, then this act expires.