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Bill Summary · SB 852

Summary of Bill: SB 852 (Session 2025, North Carolina)

Title: NC Health Benefits Exchange Implementation

Short purpose
- Authorizes the North Carolina Department of Insurance to establish and operate a state-run Health Benefits Exchange, in line with the federal Patient Protection and Affordable Care Act (PPACA) and applicable federal law.

Key provisions

1) State-run Health Benefits Exchange authority (G.S. 58-2-40)
- The bill recodifies and explicitly states that the Commissioner of Insurance must establish a State-run Health Benefits Exchange.
- The Commissioner is empowered to:
- Change existing programs, adopt or amend rules, and establish or modify policies, guidelines, or plans as needed to implement, establish, create, administer, or operate the Exchange.
- Apply for and accept federal funds related to the creation, implementation, or operation of the Exchange.
- Create advisory boards or committees to provide recommendations on the Exchange’s creation, implementation, or operation.

2) Interaction with federal Health Benefit Exchange (G.S. 143B-24)
- The General Assembly retains authority over the State’s level of interaction with the federally facilitated Health Benefit Exchange (FFE) operating in North Carolina.
- No state department, agency, or institution may contract or commit resources for services related to a federally facilitated Exchange under a “Partnership” model unless authorized by the General Assembly.
- The section clarifies that nothing prohibits interaction with the federal system that does not pursue a State-run or Partnership Exchange model.

3) Funding for establishment and operation (Appropriation)
- An appropriation of $100,000 from the General Fund to the Department of Insurance, starting in the 2026-2027 fiscal year.
- Purpose: to establish and operate a State-run Health Benefits Exchange, as authorized under G.S. 58-2-40(c).

4) Effective date
- The act becomes effective July 1, 2026.

Who is affected

  • North Carolina Department of Insurance (DINS): Responsible for implementing and operating the State-run Health Benefits Exchange and for rulemaking, policy development, and seeking federal funds for the Exchange.
  • The General Assembly: Maintains oversight and authority to define and restrict interactions with the federal Exchange, including prohibitions on state actions toward a Federally Facilitated Exchange unless expressly authorized.
  • State agencies/departments/institutions: Subject to limits on involvement with the federally facilitated Exchange unless authorized by the General Assembly.
  • Public/consumers seeking health benefit coverage: Potentially affected by the availability and design of a state-run Exchange, its eligibility determinations, and plan options, depending on subsequent rules and implementation steps.

Procedural and timeline notes

  • Filing date: April 28, 2026.
  • Key actions enabled by the bill:
    • Rulemaking and policy development by the Commissioner of Insurance to implement the Exchange.
    • Establishment of advisory bodies to guide development.
    • Potential consideration of federal funds and collaboration with federal programs as part of implementation.
  • Funding is modest ($100,000 recurring) to support initial establishment and ongoing operation, starting in FY 2026-2027.
  • Effective date: July 1, 2026.

Overall impact

  • The bill moves North Carolina toward establishing a state-operated Health Benefits Exchange, giving the Commissioner broad authority to design and run the Exchange and to seek federal support.
  • It asserts legislative control over whether the state participates in any Federally Facilitated or Partnership Exchange models, maintaining a guardrail to prevent unauthorized commitments.
  • Financial commitment is limited at the outset, with a dedicated funding line for startup and ongoing operations.

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

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