Modernize Medicaid Primary Care Rates.

2025-2026 Session Introduced by Gale Adcock and 15 co-sponsors

SB 780 would raise North Carolina Medicaid primary care payments to Medicare levels, funding $48 million annually starting 2026 to boost access and provider participation.

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Purpose and intent

The bill seeks to modernize North Carolina’s Medicaid primary care reimbursement by increasing rates to be equivalent with Medicare.

Rationale cited in the bill emphasizes:

The essential role of primary care in the health system and current under-resourcing.
The need to support access to care in rural, urban, and underserved communities.
The goal of improving overall health, sustaining provider participation in Medicaid, and preventing avoidable health costs.

Key provisions

Section 1

Funding and appropriations:

Allocates $48,000,000 in recurring General Fund dollars (plus associated receipts) to the Department of Health and Human Services (DHHS), Division of Health Benefits, starting in the 2026–2027 fiscal year.
Purpose: to increase Medicaid rates paid for primary care services.

Implementation timeline:

Rate increases to be implemented as soon as practicable after July 1, 2026.

Coverage scope:

Applies to primary care services as defined by the North Carolina Primary Care Payment Reform Task Force in its April 17, 2024 report to the General Assembly.

Section 2

Effective date:

The act becomes effective July 1, 2026.

Impact and affected participants

Who is affected?

Medicaid primary care providers in North Carolina, who would see higher reimbursement rates for covered primary care services.

Financial impact on state:

A recurring state appropriation of $48 million beginning in FY 2026–2027 to fund the increased rates.

Systemic impact:

Intended to improve access to primary care, particularly in underserved areas, by aligning Medicaid rates more closely with Medicare, potentially influencing provider participation, patient access, and overall care quality.

Procedural and timeline notes

Legislative progress:

Filed April 21, 2026; referred to Rules and Operations of the Senate; first reading on April 22, 2026.

Effective date:

The act would take effect July 1, 2026.

Administration:

DHHS, Division of Health Benefits, would administer the rate increases following the funding authorization.

Summary

SB 780 proposes a targeted fiscal and policy change to modernize Medicaid primary care reimbursement by funding rate increases to Medicare-equivalent levels. The measure hinges on a $48 million annual appropriation beginning in FY 2026–2027, with rate increases applicable to primary care services as defined by a specific task force report. If enacted, it would be effective July 1, 2026, and administered by DHHS’s Division of Health Benefits, aiming to bolster provider participation, expand access to primary care, and improve long-term health outcomes for North Carolinians, especially in underserved communities.

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