North Carolina State Health Plan

The meeting served as the inaugural session for the committee, focusing on its governance structure, roles, and objectives. Discussion topics included committee bylaws, the importance of member expertise in setting benefits and medical policies for the state health plan, procedures for handling conflicts of interest, and the committee's role as fiduciaries. Future agenda items were introduced, including the review of benefit exclusions and policies regarding durable medical equipment.

The meeting focused on the financial status of the plan, addressing past deficits and strategies for long-term structural sustainability. A major topic was the proposed three-tier provider network structure, aimed at modernizing healthcare purchasing by aligning cost, quality, and access. The executive administrator provided updates on staffing changes, including the hiring of a new senior director of finance and a lead for the pharmacy benefit program, and noted the status of ongoing TPA and PBM RFP processes. Additionally, the Board discussed the decision to auto-enroll Medicare retirees into the Medicare Advantage plan and explored plans for expanding the provider network to include maternity care, dermatology services, and independent pharmacies to address healthcare deserts.

The State Health Plan's strategic direction focuses on achieving long-term affordability, improving health outcomes, and ensuring equitable access to care. It aims to protect affordable premiums and stable benefits by actively managing healthcare costs, promoting active purchasing, rewarding quality, and linking premiums to wage increases. The plan seeks to help members achieve better health through aligned incentives, enhanced primary care access, condition-specific support, and patient navigation. Furthermore, it strives to ensure members have access to care by expanding digital health solutions, improving rural access, encouraging accessible care options from providers, and expanding collaborative mental health services.

This document presents an overview of the North Carolina State Health Plan for 2026. It outlines various health plan designs and options, such as PPO, Base, Enhanced, and 70/30 plans, detailing benefits, deductibles, and out-of-pocket maximums for active, non-medicare, and medicare members. The document also includes demographic data on plan membership across North Carolina and describes the plan's governance and fiduciary responsibilities.

The meeting commenced with the confirmation of a quorum and the recording of the Statement of Economic Interest (SEI) for newly appointed Board member Joe Slater, noting a potential conflict of interest related to Advocate Health. Key actions approved during the Consent Agenda included the minutes for the May 20, 2025 meeting, the approval of Wayne Prep Academy's application for plan participation, and the delegation of powers to the Treasurer concerning charter school applications. The Executive Administrator provided updates on the Plan's financial deficit, the need for premium adjustments, legislative funding support, provider negotiations, and the introduction of new initiatives such as the Lantern program, Hello Heart, Hinge Health, Ventricle Health, and diabetes prevention programs. The Communications Director outlined outreach strategies, including Open Enrollment preparations and the website transition to a .gov domain. The Board subsequently voted to approve the 2026 premium rates and methodology. A financial update indicated improved projections despite higher-than-expected medical claims, projecting an $800 million year-end reserve. The Board then moved into a Closed Session to consult with legal counsel regarding a vendor pre-litigation dispute and the case of Kadel v. Folwell before adjourning.