North Carolina 2023 Legislative Session Recap

Raleigh, North Carolina, USA State Capitol Building.

The North Carolina General Assembly (NCGA) adjourned its 2023 regular session on October 25, having passed 149 of the 1,659 bills introduced – 9% of the total legislation proposed this year.Looking ahead, the NCGA isn’t scheduled for another regular session until April 2024. However, legislators will reconvene for a two-day period each month to address a restricted range of topics, such as veto overrides, adjustments to election laws, and responses to legal challenges against legislative actions.

In a notable development during late October, the newly reconstituted state Supreme Court revisited and overturned a prior redistricting decision. This compelled the North Carolina General Assembly to draw new legislative and congressional maps during the final days of the session. The approved maps, which are perceived to favor Republicans, are poised to influence the political landscape for the 2024 elections, possibly impacting the balance of power in the U.S. Congress. 

Despite opposition from Democrats and anticipated legal challenges, state lawmakers ratified the new maps, which you can view here: State HouseState Senate, and Congressional districts.

Here’s a brief summary of several notable bills – pertaining to healthcare and other areas – that were passed during the 2023 legislative session:

Medicaid Expansion and Healthcare Access and Stabilization Program (HASP)

Gov. Roy Cooper signed HB 76, the Access to Healthcare Options bill, into law on March 27, expanding Medicaid access to over 600,000 North Carolinians and engaging the state in the Healthcare Access and Stabilization Program (HASP). However, Medicaid Expansion only became official after lawmakers approved a state budget, which happened on September 22. The Department of Health and Human Services (DHHS) plans to launch Medicaid expansion on December 1, 2023, changing Medicaid eligibility to include about 600,000 North Carolina residents, ages 19-64 with higher incomes. Additionally, Medicaid rates were increased and authority was created for the Secretary of the DHHS to consolidate Local Management Entities down to 4.


Lawmakers adopted the state budget on October 2, with the biennial spending plan allocating $29.8 billion for FY 2023-24 and $30.9 billion for FY 2024-25. Specifically regarding healthcare, the budget includes a $1.6 billion “signing bonus” the state received from the federal government for Medicaid expansion, with funds directed to several behavioral and rural health projects. It also allotted nearly $320 million for the construction of a new UNC Health children’s hospital, with pediatric behavioral health services, in Raleigh-Durham.

Blue Cross Blue Shield Reorganization

Lawmakers passed HB 346, which allows Blue Cross and Blue Shield of North Carolina (BCBSNC) to form a new nonprofit holding company as its parent entity. They adopted the bill despite strong opposition from the state’s Insurance Commissioner, who warned of potential premium hikes and reduced regulatory oversight by the Department of Insurance and State Treasurer. Proponents argued that the bill would grant BCBSNC greater agility in business decisions, enhancing its competitiveness in the health insurance market.

NC Health & Human Services Workforce Act

Signed into law on September 29, the NC Health & Human Services Workforce Act (HB 125) establishes safeguards for healthcare workers against workplace violence, mandating police presence in emergency rooms and developing hospital security plans informed by risk evaluations. It also facilitates the mobility of medical professionals in the military by permitting relocation licenses for physicians and physician assistants.

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