On July 11, 2022, Governor Roy Cooper signed the latest state budget into law. Passed by the North Carolina General Assembly in June, the budget provides the $27.9 billion spending plan for the upcoming state fiscal year.

Key health care provisions in the budget include:

• The waiver of several health services regulations under a pandemic, in order to ease administrative burden of increasing numbers of ambulance workers and nursing assistants, as well as increasing bed capacity in skilled nursing facilities.
• Addressing staffing shortages in long-term care: skilled nursing facilities may hire unlicensed workers to do the work of certified nurse aides for up to four months.
• Adding seven pathologists to the state Office of the Chief Medical Examiner.
• Authorization of the State Health Director to issue standing orders for vaccinations, diagnostic testing, and other COVID-19 diagnostics and treatments.
• $1.3 million in annual funding for the 9-8-8 suicide/crisis hotline. This national hotline is mandated for all states in accordance with the National Suicide Hotline Designation Act of 2020, and will launch on July 16. Calls to the hotline will be routed to local call centers. If calls cannot be resolved through the call centers, mobile mental health response teams will be dispatched, and individuals may be referred to facilities if they are in need of inpatient services.
• $7.7 million from the JUUL lawsuit settlement, which will provide tobacco cessation media campaigns and other programs aimed at young people.
• Change in composition of the state maternal mortality review committee; the committee will now be comprised of 20 members, including community representatives.
• $3 million to crisis pregnancy centers.
• $52 million to continue rate increases for in-home personal care workers and workers in skilled nursing facilities. This increase aims to bring salaries near $15/hour.
• $14.8 million from the opioid settlement for local mental health management entities to purchase medication-assisted treatment. This funding also provides for opioid treatment research and housing support for individuals in recovery, funding to the NC Association of County Commissioners for strategic planning on spending funds at the local level, and $400,000 to the University of North Carolina Injury Prevention Research Center for the Community Opioid

Resources Engine for North Carolina (NC-CORE), a data clearinghouse and resource for information on how the state is spending the settlement funds.

Notably, despite ongoing discussion within the General Assembly and with the Office of the Governor, the state budget did not include Medicaid expansion. On June 23, 2022, the North Carolina House Committee on Health heard Senate Bill 408: Rural Healthcare Access & Savings Plan Act, which addresses Medicaid expansion. Senate Bill 408 would require NC DHHS to develop a Medicaid expansion plan (called a Medicaid Modernization Plan) that meets various criteria laid out in the bill, including a requirement for the department to negotiate with the federal Centers for Medicare and Medicaid Services for a work requirement for Medicaid beneficiaries, if DHHS believes that work requirements would receive federal approval. SB408 also would create a new Joint Legislative Committee on Medicaid Rate Modernization and Savings. This committee would meet through the summer and fall of 2022, and would be tasked with deciding if the Medicaid expansion plan created by NC DHHS meets criteria and can be voted on in December.

Other criteria for the Medicaid Modernization Plan to be developed under SB408 include:

• Expand Medicaid coverage for adults aged 18-64 with incomes up to 133% of the federal poverty level.
• Fund the additional Medicaid coverage through an increase in hospital assessments.
• Develop legislation for increased hospital assessments in order to pay the nonfederal share of an increase to Medicaid hospital reimbursements through the Hospital Access and Stabilization

Program (HASP).

• Include an investment of $1 billion to address opioid, substance abuse, and mental health crises. This investment would be paid for through savings incurred from the additional federal Medicaid match available under the American Rescue Plan Act (ARPA).
• Include specific proposals for improving access to health care in rural areas of North Carolina.

SB408 also would direct the Secretary of Commerce to develop a collaborative plan for a statewide workforce development program.

This bill passed the North Carolina House on June 28, 2022. The budget signed by Governor Cooper includes the creation of the Joint Legislative Oversight Committee on Medicaid, which will examine budgeting, financing, administrative, and operational issues related to Medicaid.