Medicaid under the microscope + What to expect as session starts Tuesday
AI-generated summary reviewed by our newsroom.
- Lawmakers return with the budget spotlighted after no budget passed last year.
- Committees held hearings on Medicaid funding, fraud oversight, and involuntary commitment.
- A hospital and nursing groups are again pushing APRN autonomy bills to help rural care.
Good morning and welcome to the Under the Dome newsletter. I’m politics reporter Luciana Perez Uribe Guinassi.
The legislative session in North Carolina is about to be back in full swing.
And typically, sessions held in even-numbered years (known as the short sessions) focus on amending the budget that is supposed to be passed by late June during the prior long session, as well as tackling unfinished business.
But this year it’s different.
Last year, the GOP-led legislature failed to pass a budget for the fiscal year that ends in June. That means the budget will be in the spotlight again. Senate leader Phil Berger is also wrapping up his last year after losing reelection, and several House Democratic lawmakers who at times voted with Republicans are departing after also losing in March. That leaves a lot of uncertainty about what the session will look like, as my colleague Dawn Baumgartner Vaughan wrote in her story here.
One thing we do know so far is that the session is kicking off strong. There are over a dozen press conferences scheduled. Details have not yet been released, but these press conferences are typically used by lawmakers to push for bills they support or to speak about issues they care about. In short — advocacy.
Legislation across several topics could also crop up and be voted on promptly. Lawmakers over the past few weeks have already been engaged in committee hearings and debate. Speaker of the House Destin Hall on Wednesday published a legislative calendar on X showing he expects votes on Tuesday and Wednesday next week.
Debate has already been going on
Lawmakers’ discussions have included committee hearings on Medicaid funding needs, mental health system reform, hurricane recovery efforts in Western North Carolina, and property tax reform.
Several of those committees have led to recommendations on actions to be taken, such as a House property tax committee recommending a state constitutional amendment to place limits on local property tax hikes, and another House committee looking into the involuntary commitment process, releasing a report with recommendations. That committee was formed following the fatal Charlotte stabbing of Iryna Zarutska. One suggestion in the report was allowing involuntary commitment exams to be done online, from jail, to reduce transportation delays in getting a defendant evaluated, courts and public safety reporter Julia Coin of The Charlotte Observer reported.
As health care costs continue to rise, and with the state expected to pick up more of the tab on Medicaid following federal changes, lawmakers also held a lengthy bipartisan oversight hearing Thursday focused on whether the state was being proactive in recognizing, investigating and prosecuting fraud in the program.
Department of Health and Human Services Secretary Devdutta Sangvai and Attorney General Jeff Jackson, who were asked to testify, made the case that they were on top of the problem and delivering results, while acknowledging room for improvement and making requests of the legislature, including funding for a data mining position in the attorney general’s office.
In 2025, there were 2,494 complaints of provider fraud, waste and abuse. Of those, 112 were referred to the AG’s office and of those less than half were accepted, according to DHHS data. Sangvai said $98 million of $134 million in overpayments was recovered in 2025. Sangvai said that, based on national benchmarks, North Carolina’s Medicaid program is likely operating at roughly a 2% fraud or improper payment rate.
Many Republicans, who lead the committee, pressed that the state wasn’t doing enough. Rep. Grant Campbell, a Concord Republican who chaired the committee, pointed to cases of suspected fraud he said two staffers had identified using Google and Excel.
Campbell told The News & Observer that “there is statute language that has already been put together or being put together to address some of the concerns” that cropped up in the hearing, particularly around controlling rising Medicaid costs. Campbell said he’d “keep an eye out for that as early as the next week or two.”
Fraud in Medicaid has come up at other hearings, with applied behavior analysis therapy, or ABA, which uses positive reinforcement to help children with autism build certain skills, being a focus due to a sharp rise in spending. Read my past article on that topic here.
Be sure to tune in next week to our coverage as the session starts.
Practice autonomy for nurses
Speaking of advocacy, a push is on again to give some nurses more practice autonomy.
The call for more autonomy is for Advanced Practice Registered Nurses, who have a master’s degree — many have doctoral degrees as well — but still need a supervising physician before they can offer patients certain services in North Carolina.
Washington Regional Medical Center, a small, independent hospital in Plymouth, has joined a coalition of organizations calling for reform of APRN regulations, according to a news release from the North Carolina Nurses Association, which represents nurses in the state.
“The threats facing small hospitals are real. If Washington Regional can better deploy its APRNs, it will help insulate the facility from Medicaid cuts, rural provider shortages, and skyrocketing healthcare costs,” Tina Gordon, chief executive officer of the association, said in the news release. “APRNs give Washington Regional a proven, cost-effective way to continue meeting patients where they are, all while maintaining the quality of care that North Carolinians deserve.”
Two bills (House Bill 514 and Senate Bill 537) from last year aimed to tackle that supervision requirement.
Both bills had bipartisan support and powerful lawmakers backing them. Despite this, they failed to move in both the Senate and the House. Similar bills have cropped up in North Carolina across the years but have also failed. Meanwhile, at least 27 other states have passed similar legislation, according to the NCNA.
An organization that has previously spoken out against this type of autonomy is the North Carolina Patient Safety Association, a group of medical professionals that advocates for physician-led health care. It said the bill would remove physicians from patient care, risk patient safety, and raise health care costs without increasing access to care.
The group previously listed on its website various physician organizations, including the NC Medical Society and the NC Society of Anesthesiologists, that oppose the SAVE Act.
What the politics team has been working on
Here are some headlines from throughout the week.
- Budget standoff confronts returning NC lawmakers, but new unknowns are in the mix
- NC lawmakers use campaign funds for travel, rent and dining. Is that allowed?
- NC lawmakers are back in session next week. See how much they made in 2025.
- Former Virginia politician and wife found dead. What to know about Justin Fairfax
- No qualifying bids, so State Health Plan will restart search for new insurer
- Put property tax cap on NC ballot and close housing loophole, lawmakers say in report
- Aviation safety bill passes U.S. House after jet and helicopter collision
Thanks for reading Under the Dome
That’s all for now! Have a great weekend. We’ll see you right back here on Sunday.
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