By Jordan Meadows
Staff Writer
The Joint Legislative Oversight Committee on Medicaid in the NC General Assembly convened Tuesday afternoon to review new federal requirements and funding mechanisms for the state’s Medicaid and SNAP programs stemming from H.R.1, the "One Big Beautiful Bill Act".
The law tightens work requirements for Able-Bodied Adults Without Dependents (ABAWDs), affects eligibility for veterans and former foster youth, and mandates changes to Medicaid administration.
“NC Medicaid relies on county governments to conduct determinations on requirements for programs,” said Deputy Secretary for NC Medicaid Jay Ludlam, noting that new rules will require more frequent reporting, additional documentation from providers, and a potential shift from expansion to traditional Medicaid programs.
Sen. Jim Burgin (R-Harnett) asked about potential impacts on pregnant beneficiaries moving from expansion to traditional Medicaid through NC’s Medicaid program for pregnancy. Ludlam responded that estimates are not yet available, but cited disability or changes in circumstances as key factors affecting eligibility.
Deputy Medicaid Director Melanie Bush added that approximately 40% of determinations are automated, but as requirements increase, more caseworker input—currently about 60%—will be necessary due to errors in applications that automation cannot resolve.
To fund the new federal mandates, it was proposed that the NCGA fully cover the nonfederal share of NCHealthWorks through increased gross premium taxes, requiring an estimated $7.8 million more per quarter—nearly $32 million annually—for county eligibility determinations. Nonfederal investments will be matched with federal funds at rates up to 90% for system development and 70% for operations, with legislative action required to authorize funding adjustments and implement work requirements within federal deadlines.
H.R.1 also affects taxes, eliminating federal income tax on Social Security benefits for many seniors, and extends farm support programs such as PLC and ARC through 2031.
Rep. Hugh Blackwell (R-Burke) asked whether additional determinations would yield savings for the state. Ludlam acknowledged that while similar requirements were considered during the original Medicaid expansion, the aim is to build an efficient system that does not yet exist, and current data cannot predict where potential savings would occur.
Rep. Larry Potts (R-Davidson), co-chair of the House Efficiency Committee, questioned whether counties are the best entities to handle redeterminations or if the marketplace could play a role. And Rep. Donny Lambeth (R-Forsyth) suggested a combination of funding strategies, including leveraging state savings and increasing administrative funding, to meet the new requirements.
Committee discussions made clear that implementing H.R.1 will require significant adjustments in operations, funding, and oversight as the redeterminations move from annually to bi-annually. The NCGA is considering all options as it seeks to manage incoming work requirement determinations in a system that recently expanded to nearly 700,000 participants.
