NCGA passes several bills aiming to resolve ‘bureaucratic’ health-care delays

The North Carolina General Assembly advanced several health care-related bills this week, addressing Medicaid work requirements, hospital regulatory relief, and broader health-care reforms amid ongoing debates over the state’s health-care costs impacting providers, patients, and taxpayers alike.

Care First Act — HB 434

The Care First Act, a comprehensive healthcare reform bill, passed the House with a near-unanimous 109-1 vote, signaling strong bipartisan support. The bill aims to streamline the prior-authorization processes, enhance price transparency, and improve patient access to timely care.

“This bill will put patients first and physicians back into making decisions about health care. It protects our patients and it puts our patients before insurance company profits,” said Rep. Rep. Timothy Reeder, R-Pitt.

As Carolina Journal previously reported, HB 434 aims to eliminate red tape that causes delays in the authorization process that patients must endure in order to receive treatment. The bill would require health insurers to make timely decisions on treatment authorizations, consult with doctors before denials, and reduce the number of procedures requiring prior authorization from 2,600 to 1,600, potentially saving $1.8 billion annually.

“Right now we have cases where a psychiatrist is reviewing the care of a neurosurgeon and trying to say to the physician, ‘No, you can’t do that surgery,’ when they have no experience or they’re not even licensed in North Carolina. That is just wrong,” Reeder added.

While the House’s near-unanimous vote suggests broad agreement, Senate leaders passed their own proposal in March, raising questions about whether the chambers can find common ground before the session ends.

Medicaid Work Requirements — SB 403

In a 34-12 vote, the Senate passed SB 403, which introduces work requirements for Medicaid recipients. The bill mandates that able-bodied adults aged 19-64 meet certain minimum work requirements in order to maintain eligibility for Medicaid benefits.

“I think it’s clear with the new administration that the CMS’s [Centers for Medicare and Medicaid Services] opinion on work requirements has significantly changed,” said Sen. Ralph Hise, R-Mitchell. “And so this simply directs the Department of Health and Human Services to apply for the work requirements at CMS and to implement the approved work requirements from that process.”

The House companion bill awaits action in the Rules Committee.

Regulatory Relief for Hospitals in Disaster Zones — SB 445

SB 445, which passed the Senate unanimously with a 46-0 vote, provides temporary regulatory relief for hospitals in designated disaster zones. The bill aims to support health-care facilities after natural disasters, such as hurricanes or floods, by easing compliance burdens and helping hospitals meet community needs without navigating excessive bureaucratic hurdles during crises.

“This bill ensures that when the US Department of Health and Human Services issues temporary waivers during emergencies, North Carolina’s hospital regulations automatically align with the federal changes,” said Sen. Steve Jarvis, R-Davidson. “This means hospitals can quickly increase bed capacity, adjust staffing or modification protocols without bureaucratic delays, saving precious time when lives are at stake. I respectfully ask for your vote to vote in favor of Senate Bill 445, to ensure that North Carolina is prepared to respond to the next hurricane or disaster that we have come our way.”

Medicaid Agency Omnibus – SB 600

Another Medicaid-related bill, SB 600, also passed the Senate with a unanimous 46-0 vote. During the floor discussion, Sen. Jim Burgin, R-Harnett, outlined the four key parts of the bill, noting that the provisions are all things DHHS has asked the General Assembly to implement.

It extends federal authority for Medicaid eligibility determinations through the federal marketplace until June 30, 2028, preventing enrollment disruptions beyond the current June 30, 2025 expiration. The bill also corrects a 2024 law, simplifying Medicaid prepaid health plan enrollment for former inmates by placing them in managed-care plans 12 months after release.

Additionally, it aligns provider screening with federal regulations, tightening rules for skilled nursing facilities, portable X-ray suppliers, hospices, and certain providers previously exempt from fingerprinting. Lastly, the bill makes clarifying changes to the Medicaid subrogation statute to reflect changes from the 2021 transition to the managed-care model.

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