North Carolina Senate bill seeks to adjust Medicaid funding for changes in cost and enrollment

Sen. Dan Blue has introduced a measure intended to ensure that Medicaid funding matches projections for enrollment changes, cost factors, and updated federal guidelines, according to the North Carolina State Senate.

Filed as SB 779 on April 21 for the 2025 regular legislative session, the proposal carries the short title: ‘Medicaid Rebase.’

Below is our summary, referencing the full bill text, to clarify its key provisions where helpful.

The legislation would allocate $319 million in recurring appropriations from the state’s General Fund to the Department of Health and Human Services, Division of Health Benefits, for each year of the 2025-27 fiscal biennium. These funds are to cover projected Medicaid changes, including shifts in the number of enrollees, population demographics, service and capitation expenses, and adjustments to federal matching funds. Its effective date retroactively begins July 1, 2025, aiming to keep Medicaid finances aligned with projected demands and shared federal costs.

Among all sponsors, Kandie D. Smith introduced the highest number of bills (56) during the 2025 regular legislative session.

In North Carolina, legislation undergoes a multi-step approval process. Once a lawmaker files a bill, it is assigned to a committee, then must be considered on the floor three times in each chamber. If one chamber amends a bill the other has passed, a consensus on the final bill must be reached. Approval by both chambers sends the bill to the governor, who then has 10 days—or 30 if the legislature isn’t in session—to sign, veto, or allow it to automatically become law.

Blue earned his undergraduate degree from North Carolina Central University in 1970, later receiving a JD from Duke University.

Blue, a Democrat, joined the North Carolina State Senate in 2009 to represent the 14th District, succeeding Vernon Malone.