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Read. Follow. Verify.North Carolina restricts future Medicaid health plan contracts to statewide coverage and prioritizes provider satisfaction
Last action · April 15, 2025: Serial Referral To Finance Stricken (House action)Sponsors: Tim Reeder and 5 others
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What This Bill Would Do
North Carolina requires all future Medicaid contracts to cover the entire state rather than specific regions, caps the number of contracts at four, and gives evaluation preference to provider-led entities and bidders with higher provider satisfaction scores.
Medicaid enrollees and health insurers face a restructured procurement process that eliminates regional contracts for future plan cycles and favors entities with established provider satisfaction metrics.
- North Carolina operates a Medicaid managed care program known as NC Medicaid Direct and NC Medicaid Managed Care, administered by the Department of Health and Human Services. context
- Prepaid Health Plans (PHPs) and Provider-Learned Entities (PLEs) contract with the state to deliver comprehensive medical services to enrolled Medicaid beneficiaries. context
Who It Would Affect
Groups the bill's text would affect if enacted, as described in the record. Being affected is not a position for or against it.
Medicaid recipients
Enrollees will receive coverage through statewide rather than regional Prepaid Health Plan contracts.
Prepaid Health Plans
Bidders and plan operators face a cap of four statewide contracts and new evaluation criteria favoring provider satisfaction.
Provider-Led Entities
PLEs will receive higher evaluation weight in future contract procurements.
Key Facts
You don't have to trust us. Each fact below is taken straight from the official document - click any one to see the exact passage, highlighted in the original.
Frequently Asked Questions
Will there still be regional Medicaid health plan contracts in North Carolina?
How many total contracts are allowed for future Prepaid Health Plans?
What criteria will be prioritized when evaluating future contract bids?
What else do you want to know?
News Coverage
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Votes, people, money & the original sourceWhere This Stands
Currently in committee. The next step in the legislative lifecycle is Floor Vote.
Procedural history
5 actions- Apr 15, 2025HouseSerial Referral To Finance Stricken
- Apr 15, 2025HouseSerial Referral To Insurance Stricken
- Mar 31, 2025HouseRef to the Com on Health, if favorable, Insurance, if favorable, Finance, if favorable, Rules, Calendar, and Operations of the House
- Mar 31, 2025HousePassed 1st Reading
- Mar 27, 2025HouseIntroducedFiled
Version history
Only one version on file - nothing to compare yet. As later stages (committee substitute, engrossed, enrolled) are captured, the redline appears here.
View official text →Lobbying Activity
No state lobbying filings in our records match this bill. Federal lobbying reports (LDA) cover Congress, so they are not listed on state bills.
Full breakdown
Who this bill affects and the strongest case for and against it, written only from the bill’s own text.
Sponsors
Show 1 more sponsor
Discoveries
Patterns POLISCOPE noticed across the record. These are observations to investigate, not conclusions.
Elimination of Regional Medicaid Contracts
The legislation phases out regional standard benefit plan contracts in favor of an exclusively statewide contracting model for future procurement cycles.
Connected Entities
Sources
www.ncleg.gov
Analysis Score
0–100- Significance65How much this matters to a regular citizen
- Controversy30Intensity of disagreement among stakeholders
- Entertainment5Compellingness for a non-policy-wonk reader
- Buzz25Current news / social attention level
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