House Unveils Fiscally Responsible Plan to Fund Medicaid Rebase and Ensure Long-Term Stability
The Big Picture
North Carolina House Republicans rolled out a revised version of Senate Bill 403, aiming to fully fund the state’s Medicaid rebase without cutting provider rates or threatening state employee pay raises.
By the Numbers
$192M: New appropriations for Medicaid.
$792M: Total Medicaid rebase + administration funding this year (includes $600M already enacted).
5%: Flexible vacant position cut across state agencies to offset costs.
Key Offsets & Cuts
Elimination of some vacant DHHS positions.
5% cut in vacant positions across other gubernatorial agencies.
End Medicaid coverage for GLP-1 drugs when prescribed solely for weight loss (coverage remains for federally required medical diagnoses).
Additional Provisions
State Auditor to review SNAP and Medicaid redetermination processes.
New standards for timeliness and accuracy in Medicaid redeterminations, enforced at county level.
Medicaid redeterminations added to Rylan’s Law oversight requirements.
What They’re Saying
Rep. Donny Lambeth (R-Forsyth): Called the plan “the responsible way forward” to stabilize Medicaid while protecting patients.
Rep. Larry Potts (R-Davidson): Framed it as fiscally responsible, emphasizing efficiency and accountability.
Rep. Timothy Reeder, MD (R-Pitt): Warned disruptions in Medicaid harm patients and providers; said the plan ensures stability.
Rep. Donna White (R-Johnston): Drew on her nursing background, saying steady, reliable care “saves lives.”
Why It Matters
Medicaid rebase funding is a recurring pressure point in state budgets.
The House plan is designed to avoid politically divisive cuts by NCDHHS, while tightening accountability at both the state and county levels.
Adds a layer of auditing and enforcement that could reshape how Medicaid redeterminations are handled in North Carolina.
Raleigh, NC — Today, North Carolina House leaders released a proposed committee substitute for Senate Bill 403, a plan to fully fund the state’s Medicaid rebase while protecting teacher and state employee pay raises and avoiding new provider rate cuts. This plan is the result of close collaboration between the House, executive branch and other stakeholders.
Senate Bill 403 appropriates $192 million in additional funding, bringing the General Assembly’s total Medicaid rebase and Medicaid administration investment this year to $792 million, following $600 million previously enacted.
The plan achieves this through targeted offsets and funding transfers, including:
A vacant position cut at DHHS.
A 5% flexible vacant position cut across other gubernatorial state agencies.
Ending Medicaid coverage of GLP-1 drugs for weight-loss only (coverage remains for federally required medical diagnoses).
Additional provisions in SB 403 include:
Directing the State Auditor to review SNAP and Medicaid redetermination processes at the state and county levels to help reduce backlogs.
Requiring NCDHHS to work in collaboration with the Auditor’s office to establish standards for timeliness and accuracy for Medicaid redeterminations and an enforcement mechanism for county compliance with the newly set standards.
Adding Medicaid redeterminations to Rylan’s Law, requiring DHHS and the Auditor’s office to establish standards for timeliness and accuracy.
House Appropriations Senior Chair Donny Lambeth (R-Forsyth) said, “A strong health care system builds a stronger North Carolina. Our plan is the responsible way forward by avoiding NCDHHS’s politically motivated cuts and ensuring stability for patients who need it most.”
Health Appropriations Co-Chair Larry Potts (R-Davidson) said, “House Republicans have put forward a fiscally responsible plan that fully funds Medicaid, strengthens efficiency and accountability, and protects patients and taxpayers. We are committed to moving this plan forward without letting unrelated budget items get in the way.”
Health Appropriations Co-Chair Timothy Reeder, MD (R-Pitt) said, “As a physician, I’ve seen firsthand how even brief disruptions in Medicaid can devastate patients and the providers who care for them. This plan keeps Medicaid reliable for patients, stable for providers, and sustainable for the future.”
Health Appropriations Co-Chair Donna White (R-Johnston) said, “My experience in nursing has taught me that steady, reliable, and affordable health care saves lives. This plan strengthens North Carolina’s health care system while ensuring financial responsibility for the future.”
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