Primary House Sponsors: Rep. Charles Graham (D-Robeson); Rep. Verla Insko (D-Orange); Rep. Garland Pierce (D-Hoke, Scotland); Rep. Raymond Smith, Jr. (D-Sampson, Wayne)
Summary
This bill:
- Deems individuals part of the Medicaid coverage gap and eligible for Medicaid benefits if all of the following requirements are met: (1) the individual has a modified adjusted gross income that is at or below 133% of the federal poverty level; (2) the individual is between the ages of 19 and 65; (3) the individual is not entitled to or enrolled in Medicare benefits under part A or Part B of Title XVIII of the federal Social Security Act; and (4) the individual is not otherwise eligible for Medicaid coverage as it existed on January 1, 2020.
- Requires DHHS to provide benefits to eligible beneficiaries in the Medicaid coverage gap through an Alternative Benefit Plan unless that beneficiary is exempt from mandatory enrollment under federal law.
- Requires copayments for benefits provided under the Alternative Benefit Plan to be the same as copayments required for Medicaid beneficiaries not under the Plan.
- Requires DHHS to provide coverage for individuals deemed to be part of the Medicaid coverage gap.
- States that it is the General Assembly’s intent to impose a Medicaid Coverage Gap Assessment that will pay for the State share of the costs associated with Medicaid expansion upon hospital providers paying the supplemental assessment or base assessment required by the Hospital Assessment Act.
Movement
Filed – 3/31/2021