ADULT CARE HOME MEDICAID PCS COVERAGE.

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View NCGA Bill Details(link is external)2025-2026 Session
House Bill 485 (Public) Filed Monday, March 24, 2025
AN ACT TO REQUIRE A REQUEST FOR FEDERAL APPROVAL TO EXTEND MEDICAID ELIGIBILITY FOR PERSONAL CARE SERVICES TO CERTAIN INDIVIDUALS RESIDING IN ADULT CARE HOMES.
Intro. by Sauls, Potts.

Status: Ref to the Com on Health, if favorable, Judiciary 1, if favorable, Rules, Calendar, and Operations of the House (House action) (Mar 25 2025)

SOG comments (1):

Identical bill

Substantively identical to S 699, filed 3/25/25.

H 485

Bill Summaries:

  • Summary date: Mar 24 2025 - View Summary

    Requires the Department of Health and Human Services, Division of Health Benefits (DHB), in consultation with stakeholders, to submit a request meeting the following goals to the Centers for Medicare and Medical Services (CMS) that: (1) provides Medicaid coverage of personal care services to residents in licensed adult care homes and special care units whose income exceeds the State-County Special Assistance Program limits, but does not exceed either 180% of the federal poverty level (for those who would otherwise qualify for State-County Special Assistance at the basic rate) or 200% of the federal poverty level (for those who would otherwise qualify for State-County Special Assistance at the enhanced rate); (2) ensures cost of any new Medicaid coverage requested is offset by savings or cost avoidance; and (3) ensures compliance with applicable legal requirements. Requires DHB to take any necessary actions to implement this act and submit the request to CMS within 90 days of the act becoming law.

    DHB can only implement Medicaid coverage described in the request if it is approved by CMS and it meets all of the goals described above.