Senate Bill 448 would change North Carolina’s Medicaid buy-in program for workers with disabilities, known as the Health Coverage for Workers with Disabilities (HCWD) program. The bill directs the Department of Health and Human Services to seek federal approval to eliminate two financial eligibility tests for HCWD: the unearned income limit and the resource limit. Once CMS approves the change, the state would implement the revised eligibility rules and notify the Revisor of Statutes of the effective date.
The bill also rewrites the HCWD eligibility statute to reflect the new framework. It keeps the age, disability, and work-related requirements, but removes the income and asset barriers that currently restrict participation. The bill preserves the program’s premium, fee, and copayment structure for higher-income participants, and it allows continued coverage for up to 12 months if a participant becomes involuntarily unemployed, including for health reasons, so long as other conditions are met. It also includes a provision allowing the Department to impose additional earnings requirements for individuals whose eligibility is based on medical improvement.
Impact
If enacted and approved by CMS, the bill would broaden access to HCWD by making it easier for people with disabilities to qualify for Medicaid coverage while working. It would amend G.S. 108A-66.1 to remove statutory references to unearned income and resource limits, thereby changing state eligibility law for the Medicaid buy-in category. The bill also appropriates recurring state and federal funds for the 2025-2027 biennium to support implementation and the associated federal match, affecting DHHS Division of Health Benefits funding and administration.
Sentiment
The bill’s title and structure indicate a generally supportive policy goal: reducing employment barriers for people with disabilities and encouraging work without risking health coverage. Although no committee transcript or vote record is provided, the bill appears designed as a pro-access, pro-employment Medicaid reform. The absence of recorded opposition or amendments in the provided materials suggests no documented public controversy in the available context, but the proposal does involve a federal approval process and state funding commitment.
Contention
The main policy issue is the removal of financial eligibility limits for HCWD, which could expand enrollment and state/federal costs while making the program more accessible. Potential points of contention include whether eliminating the unearned income and resource tests could increase program expenditures, how the Department will define and verify “substantial and reasonable work effort,” and whether additional earnings requirements for medically improved participants could create new administrative barriers. Another possible concern is the bill’s reliance on CMS approval before the changes take effect, meaning implementation depends on federal consent as well as state action.