H525 - Medicaid Modernization

• Creates independent Health Benefits Authority to govern North Carolina's Medicaid and NC Health Choice programs, replacing Department of Health and Human Services oversight, with a board of experts in health administration, insurance, actuarial science, economics, and health law appointed by Governor and General Assembly.

• Transforms Medicaid from fee-for-service to full-risk capitated health plans beginning July 1, 2017, with provider-led plans phasing in full risk over two years by July 1, 2019, and establishes regional health plan competition with multiple plans per region.

• Establishes Medicaid Reserve Account with 9-25% fund balance targets of annual General Fund claims expenditures to manage budgetary shortfalls after implementation of midyear cost corrections.

• Requires Health Benefits Authority to develop detailed reform plan by April 15, 2016 addressing regional definitions, risk-adjusted rates, performance metrics, provider accountability, and IT infrastructure, with semiannual progress reports through September 1, 2021.

• Creates Joint Legislative Oversight Committee on Health Benefits Authority with 14 members (7 Senate, 7 House) to examine budgeting, financing, and operational issues related to Medicaid and NC Health Choice programs.