HB 655 – NC Health Care for Working Families

HB 655 – NC Health Care for Working Families

Primary Sponsors: Rep. Donny Lambeth (R-Forsyth), Rep. Greg Murphy (R-Pitt), Rep. Josh Dobson (R-Avery), Rep. Donna White (R-Johnston) 

Bill Summary

This bill seeks to provide health coverage to residents of NC under the NC Health Care for Working Families Program and to establish the NC Rural Access to Healthcare Grant Program.

This bill directs the Department of Health and Human Services shall design a program to be known as the “NC Health Care for Working Families”. The bill encourages DHHS is encouraged to advocate to the federal government for any changes to the current operations of the Medicaid program at the federal level in order to obtain approval for the program with maximum federal financial participation.

Population Coverage

The bill states that plan participants must meet the following criteria:

  • Resident meets all federal Medicaid citizenship and immigration requirements
  • Resident is not eligible for Medicaid currently
  • Residents modified adjusted gross income 133% of the federal poverty level
  • Resident  is not entitled to or enrolled in Medicare Part A or Medicare
  • Resident is between the ages of 19-64

The bill states that the benefit package shall be similar to NC’s 2017 Essential Health Benefits Benchmark Plan and the BCBS NC Blue Option Preferred Provider Organization Plan. The plan shall comply with all federal requirements governing Alternative Benefit Plans.

The plan shall focus on preventative care and wellness.

The Prepaid Health Plans shall manage the benefits for this patient population.

Participant Contributions

The bill states that all participants shall pay an annual premium, billed monthly, at 2% of the participant’s household income.

A participant’s failure to make a premium contribution within 90 days of the due date shall result in the suspension of the program participant from the program. The program can be reactivated if eligibility is met and the total amount in unpaid premiums is paid.

DHHS would be responsible for adopting rules related to premium requirements.

The exemption from premium requirements shall include only the following criteria:

  • Participant’s household income is 50% of the federal poverty guidelines
  • Medical hardship
  • Financial hardship
  • Indian Health Services beneficiary
  • Veteran in transition but actively seeking employment

Program Requirements

Co-payments

  • Co-payments shall be comparable with the NC Medicaid Plan.

Preventative Care/Wellness

  • DHHS shall establish preventative care and wellness activities
  • Shall include: routine physicals, mamograms, colonoscopies, weight management, and other routine screenings

Mandatory Employment

  • DHHS shall adhere to federal guidance and align work requirements to Able-Bodied Adults Without Dependants policy under the Supplemental Nutrition Assistance Program

Measures and Goals

The bill would be built on defined measures and goals for risk adjusted health outcomes, quality, patient satisfaction, access, and cost.

Funding

Funding shall come from the following sources:

  • Federal
  • Participant Contributions
  • State and County funds (including but not limited to hospital assessments)

Implementation Contingencies

The bill lists 6 contingencies that the State shall not be bound to provide coverage if any of the contingencies occur.

NC Rural Access to Healthcare Grant

This bill would create the NC Rural Access to Healthcare Grant under the DHHS Office of Rural Health. Any qualified applicant could apply for funding for the following activities:

  • Health provider recruitment to rural areas
  • Loan forgiveness for providers in rural areas
  • Rural health provider retention/incentive programs
  • Telehealth expansion
  • Medical technology modernization in rural areas
  • Activities that address opioid abuse in rural areas
  • Infant mortality reduction efforts
  • Modernization of Health IT
  • Expansion of mental health services

Bill Movement

This bill was filed on April 9, 2019.

This bill was referred to the following House Committees:

  • Health
    • A proposed committee substitute was introduced on July 9, 2019, to include a provision that states that this bill would not become law unles HB 996 (the budget) becomes law.
  • Insurance – referral stricken on July 9, 2019.
  • Rules- referral stricken on July 9, 2019.

This bill was placed on the House Calendar for July 9, 2019.

 
 

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1 Comment

  • Thomas DuBose, MD, MACP

    This is not a proposal worthy of support by NCMS. The working proposal will require a layer of bureaucracy within the state that has little experience in being able to fulfill its strict requirements, to define a sole family member healthcare provider, the physicality or mentally disabled, or even those already employed. The stated attempt to improve the quality of care and outcomes has no stated action plan or enforcement clause. It’s pro hospital and insurance industry.

 
 

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