H.B. 809
GENERAL ASSEMBLY OF NORTH CAROLINA
May 4, 2021
SESSION 2021 HOUSE PRINCIPAL CLERK
H D
HOUSE BILL DRH30285-MR-122
Short Title: NC Healthy Family Act. (Public)
Sponsors: Representative Cunningham.
Referred to:
1 A BILL TO BE ENTITLED
2 AN ACT TO EXPAND MEDICAID IN NORTH CAROLINA.
3 Whereas, by maximizing health care coverage through Medicaid expansion, 626,000
4 North Carolinians would gain access to comprehensive health care coverage; and
5 Whereas, the COVID-19 pandemic has exposed and exacerbated challenges, barriers,
6 and inequalities within the health care system that existed before the pandemic. A new urgency
7 to maximizing health care access for essential and front-line workers in North Carolina is
8 essential to the overall health of North Carolinians across the State; and
9 Whereas, many people who could gain coverage through Medicaid expansion are
10 essential or front-line workers who are noted to be at elevated risk from COVID-19. These
11 workers are continuing to provide care to some of our most vulnerable citizens in North Carolina
12 communities; and
13 Whereas, North Carolina is experiencing a behavioral health crisis that has been
14 exacerbated by the COVID-19 pandemic causing a significant increase in depression, anxiety,
15 and opioid overdoses; and
16 Whereas, the data for 2021 indicates that 204,000 adults with any mental health illness
17 (AMI) are uninsured in North Carolina. Adult prevalence of mental illness in North Carolina is
18 estimated to be 1,469,000 people. Approximately 833,000 adults with AMI did not receive
19 treatment. Approximately 358,000 adults experienced suicide ideation. Approximately 98,000
20 youth with severe major depressive episodes (MDE) are identified in the State. Around 77,000
21 youth with MDE are not receiving treatment in 2021. There are estimated to be 33,000 children
22 with private health insurance that does not cover mental or emotional problems. There are
23 approximately 544,000 adults experiencing substance use disorder in North Carolina.
24 Approximately 343,530 adults with cognitive disabilities could not see a doctor due to cost; and
25 Whereas, North Carolina ranks 44th in the country for access to care, 24th in the
26 country for the prevalence of mental illness, and 26th in the country for mental health workforce
27 need according to the 2021 State of Mental Health in America Report; and
28 Whereas, Medicaid expansion has demonstrated a reduction in opioid overdoses,
29 improvement in access to behavioral health services, increased treatment for opioid use disorder,
30 and increased providers enrolling with Medicaid to provide substance use disorder services; and
31 Whereas, Medicaid expansion would strengthen our rural communities by improving
32 access to care and the sustainability of the rural hospital workforce; and
33 Whereas, rural residents are 40% more likely to be uninsured and eligible for
34 Medicaid. On average, health care access for between 7.4% to 12.8% of people residing in rural
35 counties would gain access to comprehensive health care coverage; and
*DRH30285-MR-122*
 General Assembly Of North Carolina Session 2021
1 Whereas, 11 rural hospitals have closed since 2005 and many others have cut health
2 care services, and six rural hospitals have financial risk. These hospitals serve communities of
3 about 180,000 people in rural counties; and
4 Whereas, Medicaid expansion would assist with reducing health care disparities in
5 marginalized and underserved communities in North Carolina; and
6 Whereas, infant mortality rate decline is greater in states that have expanded
7 Medicaid, and there is a greater decline in the mortality rate among African American infants
8 according to the American Journal of Public Health; and
9 Whereas, research has shown that Medicaid expansion has been linked to better health
10 outcomes, including increased access to primary care, preventative health services, and
11 medications, as well as lower out-of-pocket expenses; and
12 Whereas, by expanding Medicaid now, North Carolina becomes eligible for $2.4
13 billion in federal monies for over two years; and
14 Whereas, if North Carolina expands Medicaid with coverage beginning by July 1,
15 2021, then the State qualifies for the increased federal medical assistance percentage (FMAP)
16 match through June 2023; and
17 Whereas, the 5% increase in the FMAP would layer on top of the 6.2% FMAP
18 increase that the State is receiving for the duration of the public health emergency; Now,
19 therefore,
20 The General Assembly of North Carolina enacts:
21 SECTION 1.(a) Section 3 of S.L. 2013-5 is repealed.
22 SECTION 1.(b) G.S. 108A-54.3A is amended by adding a new subdivision to read:
23 "(24) Individuals between the ages of 19 and 65 with modified adjusted gross
24 incomes that are at or below one hundred thirty-three percent (133%) of the
25 federal poverty guidelines and who are not entitled to or enrolled in Medicare
26 benefits under Part A or Part B of Title XVIII of the federal Social Security
27 Act."
28 SECTION 1.(c) The Department of Health and Human Services is directed to
29 provide coverage for individuals under G.S. 108A-54.3A(24), as enacted under subsection (b) of
30 this section, in a manner consistent with S.L. 2015-245, as amended.
31 SECTION 1.(d) The costs associated with implementing this act shall be funded
32 with federal funds received due to the temporary increase in the federal medical assistance
33 percentage (FMAP) under section 9814 of the American Rescue Plan Act of 2021, P.L. 117-2.
34 When funds associated with that increase in FMAP are no longer sufficient, it is the intent of the
35 General Assembly to impose upon hospital providers paying the supplemental assessment or base
36 assessment under Article 7A of Chapter 108A of the General Statutes, as enacted in Section 15.1
37 of S.L. 2020-88, an additional assessment that will pay for the State share of the program and
38 administrative costs associated with coverage for individuals under G.S. 108A-54.3A(24), as
39 enacted under subsection (b) of this section.
40 SECTION 2. This act becomes effective July 1, 2021.
Page 2 DRH30285-MR-122


Statutes affected:
Filed: 108A-54.3A
Edition 1: 108A-54.3A