SL 2026-1 — Medicaid rewrite, HASP off-ramp, and a Greensboro megaproject
An act making various budget, Medicaid, HASP, social services, education, JDIG, justice, and transportation adjustments.
Primary bill · HB 1
A budget-adjustment vehicle whose center of gravity is Medicaid — sixteen Division of Health Benefits sections rewrite PHP network rules, copays, ABA policy, and program-integrity authority. Hospital assessment changes (HASP) name NCHA explicitly as DHHS's consultation counterparty.
Part I — General Provisions
| Section | Subject | Impacted industries | Likely lobbying principals |
|---|---|---|---|
| 1.1 | Extends reversion date on FY23-24 / FY24-25 directed grants to 6/30/2027 | Nonprofits, local governments, universities holding unspent directed grants | Impacted industries Nonprofits, local governments, universities holding unspent directed grants Likely lobbying principals |
Part II — Education
| Section | Subject | Impacted industries | Likely lobbying principals |
|---|---|---|---|
| 2.1 | Establishes NC Blue Ribbon Commission on Public Education; $300K to Friday Institute (NC State) | K-12 public education; UNC System; ed-policy research; ed-tech | Impacted industries K-12 public education; UNC System; ed-policy research; ed-tech Likely lobbying principals |
| 2.2 | Conforms NC 529 plan eligible expenses to federal Code as of 7/4/2025 (OBBBA) | 529 plan administrators; financial services; private K-12 / homeschool (newly eligible expenses under OBBBA) | Impacted industries 529 plan administrators; financial services; private K-12 / homeschool (newly eligible expenses under OBBBA) Likely lobbying principals |
| 2.3 | $1M to top up Children of Wartime Veterans scholarships for 2025-26 | Higher education; veterans services | Impacted industries Higher education; veterans services Likely lobbying principals |
| 2.4–2.5 | Doubles Class II/III Wartime Veterans scholarships (100→200); $10M recurring from Escheat Fund; extends program flexibility to 2026-27 | Same as 2.3 | Impacted industries Same as 2.3 Likely lobbying principals |
Part III-A & III-B — Definitions; Rural Health Transformation Program reporting
| Section | Subject | Impacted industries | Likely lobbying principals |
|---|---|---|---|
| 3B.1 | DHHS quarterly reporting to LegOps on NC Rural Health Transformation Plan (federal RHTP under OBBBA §71401) | Rural hospitals; FQHCs; rural health clinics; EMS; rural broadband/telehealth; ag-health nonprofits | Impacted industries Rural hospitals; FQHCs; rural health clinics; EMS; rural broadband/telehealth; ag-health nonprofits Likely lobbying principals |
Part III-C — Division of Health Benefits (Medicaid)
| Section | Subject | Impacted industries | Likely lobbying principals |
|---|---|---|---|
| 3C.1 | Sunsets non-statutory Medicaid modifications after 6/30/2027 | All Medicaid stakeholders | Impacted industries All Medicaid stakeholders Likely lobbying principals |
| 3C.2 | $319M Medicaid rebase from Contingency Reserve; funds Children & Families Specialty Plan launch (Dec 2025) | Medicaid PHPs; behavioral health providers; foster care/child welfare providers | Impacted industries Medicaid PHPs; behavioral health providers; foster care/child welfare providers Likely lobbying principals |
| 3C.3 | LME/MCO intergovernmental transfers: $18.028M/yr from Alliance, Partners, Trillium, Vaya | LME/MCOs and the public-sector behavioral health system | Impacted industries LME/MCOs and the public-sector behavioral health system Likely lobbying principals |
| 3C.4 | Aligns Medicaid statute with OBBBA: "community engagement" instead of work requirements; immigrant-eligibility tightening | Medicaid expansion population; immigrant-services nonprofits; safety-net hospitals | Impacted industries Medicaid expansion population; immigrant-services nonprofits; safety-net hospitals Likely lobbying principals |
| 3C.5 | New community engagement (work) requirements at application and redetermination, effective 1/1/2027 | Same as 3C.4; NCWorks contractors; county DSS | Impacted industries Same as 3C.4; NCWorks contractors; county DSS Likely lobbying principals |
| 3C.6 | Monthly (vs. quarterly) eligibility data checks; expands data sources | Medicaid IT vendors; county DSS; eligibility-verification vendors | Impacted industries Medicaid IT vendors; county DSS; eligibility-verification vendors Likely lobbying principals |
| 3C.7 | Bars self-attestation as sole verification evidence | Same as 3C.6 | Impacted industries Same as 3C.6 Likely lobbying principals |
| 3C.8 | Counts income of ineligible (immigration-status) household members | Mixed-status families; immigrant-serving orgs | Impacted industries Mixed-status families; immigrant-serving orgs Likely lobbying principals |
| 3C.9 | Requires DHHS to refer unverified applicants to DHS/ICE | Immigrant communities; legal aid; civil rights orgs | Impacted industries Immigrant communities; legal aid; civil rights orgs Likely lobbying principals |
| 3C.10 | State Auditor performance audit of Medicaid and NCWorks; $500K | DHHS; NCWorks ecosystem; Medicaid contractors | Impacted industries DHHS; NCWorks ecosystem; Medicaid contractors Likely lobbying principals |
| 3C.11 | Annual fraud/waste/abuse reporting requirement | Medicaid providers; program-integrity vendors | Impacted industries Medicaid providers; program-integrity vendors Likely lobbying principals |
| 3C.12 | Rewrites PHP network rules: "open network" default; "any willing provider" for essential providers; LME/MCO + CAF plan apply same rules | PHPs (5 statewide + regional); FQHCs; rural health clinics; free clinics; local health depts; State Veterans Homes; tribal/IHS providers; physician groups | Impacted industries PHPs (5 statewide + regional); FQHCs; rural health clinics; free clinics; local health depts; State Veterans Homes; tribal/IHS providers; physician groups Likely lobbying principals |
| 3C.13 | Allows PHPs to perform prepayment claims review; tightens "clean claims" rate from 70% to 80%; allows PHP to drop providers failing review | PHPs; all Medicaid-billing providers | Impacted industries PHPs; all Medicaid-billing providers Likely lobbying principals |
| 3C.14 | Plan for "program integrity & efficiency" — including GLP-1 weight-loss management, AMH care-management risk-sharing, etc. | PHPs; Advanced Medical Homes; primary care; obesity/endocrinology providers; pharma (GLP-1 makers) | Impacted industries PHPs; Advanced Medical Homes; primary care; obesity/endocrinology providers; pharma (GLP-1 makers) Likely lobbying principals |
| 3C.15 | Allows PHPs to require itemized bills for outlier inpatient claims (\>$250K or 2σ above median) | PHPs vs. hospital revenue cycle | Impacted industries PHPs vs. hospital revenue cycle Likely lobbying principals |
| 3C.16 | Sets all Medicaid copays to federal max (effective 7/1/2027) | All Medicaid enrollees; providers (copay collection) | Impacted industries All Medicaid enrollees; providers (copay collection) Likely lobbying principals |
| 3C.17 | Extends 100%-of-FFS DME/orthotics/prosthetics rates in managed care through 6/30/2027 | DME suppliers; O&P providers | Impacted industries DME suppliers; O&P providers Likely lobbying principals |
| 3C.18 | Major rewrite of ABA/autism (CCP-8F) policy: in-person assessments; telehealth caps; supervision ratios (10–20%); RBT/ABAT certification; bans out-of-state BCBAs from enrollment | ABA therapy industry — every NC ABA provider | Impacted industries ABA therapy industry — every NC ABA provider Likely lobbying principals |
Part III-D — Hospital Assessment Adjustments (HASP / health advancement)
| Section | Subject | Impacted industries | Likely lobbying principals |
|---|---|---|---|
| 3D.1 | Legislative intent: fund OBBBA §71107 & §71119 admin costs from in-Article 7B sources | Hospitals (all acute care) | Impacted industries Hospitals (all acute care) Likely lobbying principals |
| 3D.2 | Shifts public-hospital assessments to intergovernmental transfers (IGT) | Public hospitals only: UNC Health Care System; ECU Health (Pitt County Memorial); other public acute-care | Impacted industries Public hospitals only: UNC Health Care System; ECU Health (Pitt County Memorial); other public acute-care Likely lobbying principals |
| 3D.3 | One-time 2026 hospital assessments to raise $14.3M for new admin costs (public + private) | All acute-care hospitals | Impacted industries All acute-care hospitals Likely lobbying principals |
| 3D.4 | Adds "supplemental administration component" to ongoing HASP — $3.3M/quarter state + $7.8M/quarter county admin through FY 2035-36 | Hospitals; county DSS | Impacted industries Hospitals; county DSS Likely lobbying principals |
| 3D.5–3D.6 | Reporting & true-up for admin-cost overcollection | NCHA member hospitals | Impacted industries NCHA member hospitals Likely lobbying principals |
| 3D.7 | "Off ramp": if CMS approves HASP at \<95% of max, or gross HASP \<$1.5B, or federal IGT rules tighten ≥20%, supplemental admin component zeroes out — and DHHS must give NCHA 30 days to confirm/dispute before triggering | All acute-care hospitals | Impacted industries All acute-care hospitals Likely lobbying principals |
| 3D.8 | Report by 10/1/2031 on post-2036 funding options | Hospitals | Impacted industries Hospitals Likely lobbying principals |
Part III-E — Division of Health Service Regulation
| Section | Subject | Impacted industries | Likely lobbying principals |
|---|---|---|---|
| 3E.1 | Raises adult day care overnight respite bed cap from 6 to 12; adds staffing rules | Adult day care; Innovations waiver / CAP-DA waiver providers; family caregivers | Impacted industries Adult day care; Innovations waiver / CAP-DA waiver providers; family caregivers Likely lobbying principals |
Part III-F — Division of Social Services
| Section | Subject | Impacted industries | Likely lobbying principals |
|---|---|---|---|
| 3F.1 | Bars self-attestation for SNAP; counts income of ineligible household members | SNAP recipients; food banks; county DSS | Impacted industries SNAP recipients; food banks; county DSS Likely lobbying principals |
| 3F.2 | $1M study (third-party) on centralizing all social services administration under State DHHS instead of counties | County DSS systems; consulting firms | Impacted industries County DSS systems; consulting firms Likely lobbying principals |
Part IV — Agriculture, Natural & Economic Resources
| Section | Subject | Impacted industries | Likely lobbying principals |
|---|---|---|---|
| 4.1 | Restructures the $118.1M FY25-26 JDIG-linked appropriation for the Greensboro airplane manufacturer megaproject (Piedmont Triad Airport) — adds collateralization rights for project financing, sidewalks/pedestrian bridge | Aerospace / supersonic aviation; airport authorities; construction; site-prep contractors; utilities | Impacted industries Aerospace / supersonic aviation; airport authorities; construction; site-prep contractors; utilities Likely lobbying principals |
| 4.2 | Lets Town of Hertford use Sec. 12.2(e)(82) S.L. 2023-134 funds for any water/wastewater project (not just capacity increase) | Town of Hertford; municipal water | Impacted industries Town of Hertford; municipal water Likely lobbying principals |
Part V — Justice & Public Safety
| Section | Subject | Impacted industries | Likely lobbying principals |
|---|---|---|---|
| 5.1 | $80M shortfall fill for Dept of Adult Correction | Prison operations; prison healthcare contractors; corrections officers | Impacted industries Prison operations; prison healthcare contractors; corrections officers Likely lobbying principals |
| 5.2 | $2.5M recurring + $1.2M NR to SBI | Law enforcement; forensic services | Impacted industries Law enforcement; forensic services Likely lobbying principals |
| 5.3 | $165K to extend NC Business Court case management software (separate from eCourts) | Court technology vendors; complex commercial bar | Impacted industries Court technology vendors; complex commercial bar Likely lobbying principals |
Part VI — General Government
| Section | Subject | Impacted industries | Likely lobbying principals |
|---|---|---|---|
| 6.1 | $1.5M to General Assembly for operating expenses | NCGA itself | Impacted industries NCGA itself Likely lobbying principals |
| 6.2 | Reshuffles five FY23-24 OSBM directed grants — Mayland CC Foundation animal shelter → Avery/Mitchell counties; Town of Selma $800K → Johnston County EDC; Iredell County fairgrounds $5M → split between Iredell Sheriff (Lake Norman safety building) and Statesville W&WW; Harnett County Johnson Farm $1.6M → parks/greenways; Burke County Western NC Megasite → general Burke W&WW | Local governments; sheriff's offices; economic development corps; parks/recreation | Impacted industries Local governments; sheriff's offices; economic development corps; parks/recreation Likely lobbying principals |
Part VII — Transportation
| Section | Subject | Impacted industries | Likely lobbying principals |
|---|---|---|---|
| 7.1 | $13.1M recurring + $8.5M NR Highway Fund backfill for DMV credit-card receipt shortfall | DMV operations; payment processors; auto dealers (registration throughput) | Impacted industries DMV operations; payment processors; auto dealers (registration throughput) Likely lobbying principals |
Methodology
The industries and principals in this chart are Lapel’s editorial readings of who is likely lobbying which provisions, drawn from NC Secretary of State lobbyist-principal registration data and the public bill history of the underlying legislation. These are not direct attestations from the principals named, and the chart does not claim that every party listed worked the section.