House Bill 1045, titled the Fair Wages in Health Care Act, would create new occupational minimum wage floors for several direct care and health care support jobs in North Carolina. The bill sets hourly wage minimums of $18 for home care aides and direct support professionals, $20 for certified nursing assistants, $22 for psychiatric aides or technicians, and $24 for licensed practical nurses. It defines each covered occupation broadly by job duties rather than job title, and it prevents employers from avoiding the law by reclassifying workers under different titles. If an employee performs covered duties for at least 25% of a workweek, the applicable wage floor would apply for that week, with the highest applicable wage controlling when multiple categories overlap.
The bill also directs the Department of Health and Human Services and other State agencies to adjust Medicaid, waiver, managed care, and other publicly funded contract and reimbursement structures so providers can comply with the new wage requirements. DHHS would be required to seek federal approvals if needed, revise contracts and rate structures where authorized, and submit an implementation plan by October 1, 2027. The bill appropriates $500,000 from the General Fund for implementation, and the wage requirements would take effect January 1, 2028.
In terms of state law, the bill would add a new section to Article 2A of Chapter 95 of the General Statutes, creating a specific occupational wage mandate that operates alongside North Carolina’s general minimum wage law and federal wage protections. It would also affect State-funded health and human services programs, Medicaid, waiver services, managed care contracts, and other procurement or funding arrangements involving covered workers. Employers in the long-term care, home care, disability services, and behavioral health sectors would be the primary parties affected.
The overall sentiment reflected in the bill text is strongly supportive of the direct care workforce and the people who rely on these services. The findings emphasize recruitment and retention problems, workforce shortages, and the need to protect vulnerable residents by stabilizing care staffing. No committee discussion or recorded votes were provided, so there is no additional evidence of opposition or support from hearings or floor action beyond the bill’s stated purpose and findings.
The main point of contention likely would be the cost and administrative impact on providers, State agencies, Medicaid financing, and contract rates, since the bill requires wage increases to be matched by reimbursement and contract adjustments where possible. Another possible issue is the need for federal approvals and whether the appropriated implementation funding is sufficient. The bill’s broad duty-based definitions and anti-evasion language may also draw attention from employers concerned about compliance and worker classification.
HB1045 would amend Chapter 95 of the General Statutes by creating a new occupational minimum wage provision for specified direct care and health care support workers. It would establish enforceable wage floors above the general minimum wage for covered occupations and apply existing enforcement, remedies, and retaliation protections to those workers. The bill would also require DHHS and other State agencies to adjust Medicaid, waiver, managed care, and other publicly funded reimbursement or contract terms as needed to support compliance, subject to appropriations and legal authority. A $500,000 General Fund appropriation is provided for implementation, and the substantive wage requirements would apply to work performed on or after January 1, 2028.
The bill’s stated purpose and findings reflect a favorable view of direct care workers and a policy judgment that higher wages are needed to improve recruitment, retention, and continuity of care. The text frames the measure as a public health, safety, and welfare initiative designed to protect older adults, people with disabilities, and individuals receiving behavioral health services. Because no committee testimony or votes are included, there is no recorded legislative debate to indicate broader support or opposition beyond the bill’s pro-worker framing.
The likely areas of contention are fiscal and operational rather than definitional: providers and State agencies may object to the cost of raising wages, the need to renegotiate reimbursement rates and contracts, and the uncertainty of obtaining federal approvals for Medicaid and waiver financing. Employers may also scrutinize the bill’s broad duty-based coverage rules, the 25% workweek threshold, and the anti-title-avoidance language. Supporters are likely to be advocates for direct care workers, disability services, home care, and behavioral health consumers, while potential skeptics would include provider organizations, budget officials, and agencies responsible for administering publicly funded care programs.