Rep. Lambeth files bill in North Carolina House to revise Medicaid prepaid health plan contracts

A new bill filed by State Rep. Donny Lambeth in the North Carolina House seeks to revise how Medicaid prepaid health plan contracts are awarded and managed in the state, according to the North Carolina State House.

The bill, filed as HB 558 on March 27 during the 2025 regular session, was formally listed with the short title: ‘Criteria for PHP Contract Procurement.’

The following is our breakdown, based on the actual bill text, and may include interpretation to clarify its provisions.

In essence, this bill updates the criteria for procuring future Medicaid prepaid health plan (PHP) contracts in North Carolina. It stipulates that the initial standard benefit plan contracts include four statewide contracts with PHPs to cover Medicaid recipients and up to 12 regional contracts with provider-led entities (PLEs). Regional contracts must cover entire regions and can be awarded to PLEs for contiguous regions. Initial PHP contracts can be for staggered terms of three to five years to prevent coverage gaps. For subsequent contracts, all standard benefit plans will cover the entire state with no regional contracts allowed. The number of statewide contracts is limited to four, and the Division of Health Benefits will prioritize responses from PLEs and bidders with higher provider satisfaction and performance data in evaluating contract proposals. The act becomes effective immediately upon becoming law.

Of the three sponsors of this bill, Lambeth proposed the most bills (41) during the 2025 regular session.

Bills in North Carolina follow a multi-step process before becoming law. A lawmaker starts by filing a bill, which is assigned to a committee for review. The bill must be read three times in each chamber. If one chamber changes the bill after the other passes it, both must agree on the final version. Once both chambers approve the same bill, it goes to the governor, who has 10 days (or 30 if the legislature is not in session) to sign, veto, or let it become law without a signature.

You can read more about the bills and other measures here.

Lambeth graduated from High Point University in 1972 with a BA.

Lambeth, a Republican, was elected to the North Carolina State House in 2013 to represent the state’s 75th House district, replacing previous state representative Bill McGee.