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Bill Summary · SB 896

Summary of North Carolina Senate Bill 896 (Session 2025)

Title: Increase Medicaid PCS and PDN Rates

Sponsor: Senator Burgin (primary)

Status: Filed April 29, 2026

Effective Date: July 1, 2026

Purpose
- The bill aims to increase Medicaid reimbursement rates in North Carolina for two types of home- and community-based services: Personal Care Services (PCS) and Private Duty Nursing (PDN).

Key Provisions

1) Personal Care Services (PCS) rate increase
- Funding: Appropriates 120,800,000 dollars in recurring General Fund dollars (starting in FY 2026-2027) to the Department of Health and Human Services (DHHS), Division of Health Benefits (DHB).
- Rate increase: Raises the Medicaid rate for PCS to $7.50 per 15-minute increment.
- Coverage and programs affected:
- Medicaid PCS under Medicaid Clinical Coverage Policies 3L, 3K-1, and 3K-2.
- Programs:
- State Plan Personal Care Services Program (PCS)
- Community Alternatives Program for Children (CAP/C)
- Community Alternatives Program for Disabled Adults (CAP/DA)
- Community Alternatives Program Choice (CAP/CO)
- Federal match: The increase is designed to generate a state match for up to $216,200,000 in recurring federal funds for FY 2026-2027, with the corresponding funds appropriated to DHB for the same purpose.

2) Private Duty Nursing (PDN) rate increase
- Funding: Appropriates 20,100,000 dollars in recurring General Fund dollars (starting in FY 2026-2027) to the DHHS, DHB.
- Rate increase: Raises the Medicaid PDN rate to $16.25 per 15-minute increment.
- Coverage and programs affected:
- Medicaid PDN under Medicaid Clinical Coverage Policies 3G-1 (Private Duty Nursing for Beneficiaries Age 21 and Older) and 3G-2 (Private Duty Nursing for Beneficiaries Under 21 Years of Age).
- Federal match: The increase is designed to provide a state match for $35,900,000 in recurring federal funds for FY 2026-2027, with these funds also appropriated to DHB for the same purpose.

3) Administrative and General Fund Implications
- The bill explicitly earmarks recurring General Fund amounts to fund the rate increases.
- The referenced federal matching funds indicate a broadened use of federal Medicaid funds to support the higher state payments, subject to applicable federal financial participation rules.

Effective Date
- The act becomes effective July 1, 2026.

Summary of Impact

  • Beneficiaries: Medicaid recipients who utilize PCS and PDN services will receive higher reimbursement rates when these services are provided.
  • Providers: Agencies and individual providers delivering PCS and PDN services under the specified Medicaid programs may experience improved reimbursement levels, potentially affecting staffing, service availability, and access.
  • State finances: The General Fund will allocate approximately $140.9 million in total recurring funding for FY 2026-2027 to support the PCS and PDN rate increases, with significant corresponding federal Medicaid matching funds to accompany the higher payments.
  • Program scope: The rate increases apply to multiple related home-based care programs (PCS and CAP variants) and both age-specific PDN policies.

Notes
- The summary reflects the bill text as filed and does not account for subsequent amendments or legislative changes that may occur during the chamber's consideration process.

Compiled from official sources — confirm details with the bill’s official record.

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