GENERAL ASSEMBLY OF NORTH CAROLINA
SESSION 2025
S D
SENATE BILL DRS45224-NLa-14A
Short Title: Remove Employment Barriers/Ppl w Disabilities. (Public)
Sponsors: Senators Lee and Grafstein (Primary Sponsors).
Referred to:
*DRS45224 -NLa-14A*
A BILL TO BE ENTITLED 1
AN ACT TO REMOVE BARRIERS TO EMPLOYMENT FOR PEOPLE WITH 2
DISABILITIES BY REMOVING THE UNEARNED INCOME LIMIT AND THE 3
RESOURCE LIMIT FROM THE HEALTH COVERAGE FOR WORKERS WITH 4
DISABILITIES ACT UNDER THE MEDICAID PROGRAM. 5
The General Assembly of North Carolina enacts: 6
SECTION 1. No later than 90 days after this act becomes law, the Department of 7
Health and Human Services, Division of Health Benefits, shall submit the necessary 8
documentation to the Centers for Medicare and Medicaid Services (CMS) for approval to remove 9
the unearned income limit and the resource limit from the eligibility requirements for the Health 10
Coverage for Workers with Disabilities Medicaid eligibility category. Upon approval by CMS 11
of the removal of the unearned income and resource limits, the Secretary of the Department of 12
Health and Human Services shall notify the Revisor of Statutes of the effective date approved by 13
CMS for the removal. 14
SECTION 2.(a) G.S. 108A-66.1 reads as rewritten: 15
"§ 108A-66.1. Medicaid buy-in for workers with disabilities. 16
(a) Title. – This section may be cited as the Health Coverage for Workers With 17
Disabilities Act. The Department shall implement a Medicaid buy-in eligibility category as 18
permitted under P.L. 106-170, Ticket to Work and Work Incentives Improvement Act of 1999. 19
The Department shall establish rules, policies, and procedures to implement this act in 20
accordance with this section. 21
… 22
(c) Eligibility. – An Except as provided in subsection (c1) of this section, an individual 23
is eligible for HCWD if:if all of the following apply: 24
(1) The individual is at least 16 years of age and is less than 65 years of age;age. 25
(2) The individual either meets Social Security Disability criteria, criteria or the 26
individual has been enrolled in HCWD and then becomes medically improved 27
improved, as defined in Ticket to Work and as further specified by the 28
Department. An individual shall be determined to be eligible under this 29
section without regard to the individual's ability to engage in, or actual 30
engagement in, substantial gainful activity as defined in section 223 of the 31
Social Security Act (42 U.S.C. § 423(d)(4)). In conducting annual 32
redetermination of eligibility, the Department may not determine that an 33
individual participating in HCWD is no longer disabled based solely on the 34
individual's participation in employment or earned income;income. 35
FILED SENATE
Mar 24, 2025
S.B. 448
PRINCIPAL CLERK General Assembly Of North Carolina Session 2025
Page 2 DRS45224-NLa-14A
(3) The individual's unearned income does not exceed one hundred fifty percent 1
(150%) of FPG, and countable resources for the individual do not exceed the 2
resource limit for the minimum community spouse resource standard under 3
42 U.S.C. § 1396r, and as further determined by the Department. In 4
determining an individual's countable income and resources, the Department 5
may not consider income or resources that are disregarded under the State 6
Medical Assistance Plan's financial methodology, including the 7
sixty-five-dollar ($65.00) disregard, impairment-related work expenses, 8
student earned-income exclusions, and other SSI program work incentive 9
income disregards; and 10
(4) The individual is engaged in a substantial and reasonable work effort 11
(employed) effort, as provided in this subdivision and subdivision, as further 12
defined by the Department Department, and as allowable under federal law. 13
For purposes of this subsection, "engaged in substantial and reasonable work 14
effort" means all of the following: 15
a. Working in a competitive, inclusive work setting, or self-employed. 16
b. Earning at least the applicable minimum wage. 17
c. Having monthly earnings above the SSI basic sixty-five-dollar 18
($65.00) earned-income disregard. 19
d. Being able to provide evidence of paying applicable Medicare, Social 20
Security, and State and federal income taxes. 21
(c1) Additional Earnings Requirements. – The Department may impose additional 22
earnings requirements in defining "engaged in substantial and reasonable work effort" for 23
individuals who are eligible for HCWD based on medical improvement. 24
(c2) Involuntary Unemployment. – Individuals who participate in HCWD but thereafter 25
become unemployed for involuntary reasons, including health reasons, shall have continued 26
eligibility in HCWD for up to 12 months from the time of involuntary unemployment, so long as 27
the individual (i) maintains a connection with the workforce, as determined by the Department, 28
(ii) meets all other eligibility criteria for HCWD during the period, and (iii) pays applicable fees, 29
premiums, and co-payments. 30
(d) Fees, Premiums, and Co-Payments. – Individuals who participate in HCWD and have 31
countable income greater than one hundred fifty percent (150%) of FPG shall pay an annual 32
enrollment fee of fifty dollars ($50.00) to their county department of social services. Individuals 33
who participate in HCWD and have countable income greater than or equal to two hundred 34
percent (200%) of FPG shall pay a monthly premium in addition to the annual fee. The 35
Department shall set a sliding scale for premiums, which is consistent with applicable federal 36
law. An individual with countable income equal to or greater than four hundred fifty percent 37
(450%) of FPG shall pay not less than one hundred percent (100%) of the cost of the premium, 38
as determined by the Department. The premium shall be based on the experience of all 39
individuals participating in the Medical Assistance Program. Individuals who participate in 40
HCWD are subject to co-payments equal to those required under the Medical Assistance 41
Program. 42
(e) Countable Income. – In determining an individual's countable income, the 43
Department may not consider income that is disregarded under the State Medical Assistance 44
Plan's financial methodology, including the sixty-five dollar ($65.00) disregard, 45
impairment-related work expenses, student earned-income exclusions, and other SSI program 46
work incentive income disregards." 47
SECTION 2.(b) This section is effective on the date approved by the Centers for 48
Medicare and Medicaid Services for the removal of the unearned income and resource limits for 49
Health Coverage for Workers with Disabilities program eligibility, as required by Section 1 of 50
this act. 51 General Assembly Of North Carolina Session 2025
DRS45224-NLa-14A Page 3
SECTION 3. Effective July 1, 2025, there is appropriated from the General Fund to 1
the Department of Health and Human Services, Division of Health Benefits, the sum of one 2
hundred sixty-five thousand dollars ($165,000) in recurring funds for each year of the 2025-2027 3
fiscal biennium. These funds shall provide a State match for three hundred one thousand dollars 4
($301,000) in recurring federal funds for each year of the 2025-2027 fiscal biennium, and those 5
federal funds are appropriated to the Division of Health Benefits. 6
SECTION 4. Except as otherwise provided, this act is effective when it becomes 7
law. 8