North Carolina 2025 Session Status: In Committee Bipartisan · 42 D · 1 I · 1 R cosponsors

HB 1138 — Aging With Dignity Act.

Last action — Passed 1st Reading

  1. ✓
    Introduced
  2. 2
    In Committee
  3. 3
    Passed House
  4. 4
    Passed Senate
  5. 5
    To Executive
  6. 6
    Enacted

This bill is in committee in the House. Introduced April 29, 2026. It must pass committee before a floor vote.

Next likely step: a committee vote, then a floor vote in the House.

Odds of enactment

Low chance

Based on the sponsor, cosponsors, and committee posture, this bill has a low chance of becoming law.

Upgrade to see the exact probability and what's driving it.

A statistical estimate from our own model of past outcomes — an insight, not a guarantee. Policymaking is volatile.

Prognosis

Advancing 42% · moderate confidence

  • In Committee

    Current position in the legislative process.

  • 44 sponsors

    3 primary, 41 co-sponsors signed on.

  • Bipartisan support

    Sponsored across 3 parties (42 D · 1 I · 1 R) — cross-party backing.

Based on stage, sponsorship breadth, committee status, recorded votes, and cross-state momentum — a description of the observable signals, not a prediction.

Bill Text

What changed in the latest version

39 added · 38 removed

Plain-language change summary

The recent changes to House Bill 1138, now titled the Aging With Dignity Act, include expanded provisions aimed at enhancing care for older adults. It emphasizes that individuals aged 55 and older should be allowed to live in their own homes and communities and focuses on coordinating care among different healthcare providers. This matters because it seeks to provide better support for the aging population, ensuring they can maintain their independence while receiving necessary health services.

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GENERAL ASSEMBLY OF NORTH CAROLINA H.B.
GENERAL ASSEMBLY OF NORTH CAROLINA SESSION 2025 H 1 HOUSE BILL 1138 Short Title:
1138 Apr 29, 2026 SESSION 2025 HOUSE PRINCIPAL CLERK H D HOUSE BILL DRH10581-MGa-149 Short Title:Aging With Dignity Act.
Aging With Dignity Act.
Representative Ball.
Representatives Ball, G.
Pierce, G.
Brown, and Pittman (Primary Sponsors).
For a complete list of sponsors, refer to the North Carolina General Assembly web site.
A BILL TO BE ENTITLED AN ACT PROMOTING AGING WITH DIGNITY BY STRENGTHENING HOME- AND COMMUNITY-BASED CARE;
Appropriations, if favorable, Rules, Calendar, and Operations of the House May 4, 2026 A BILL TO BE ENTITLED AN ACT PROMOTING AGING WITH DIGNITY BY STRENGTHENING HOME- AND COMMUNITY-BASED CARE;
(2) Olderadultsoverwhelminglyprefertoremainintheirhomesandcommunities when appropriate, yet access to home- and community-based services is limited by workforce shortages, long waitlists, geographic disparities, and administrative barriers.
(2) Olderadultsoverwhelminglyprefertoremainintheirhomes and communities when appropriate, yet access to home- and community-based services is limited by workforce shortages, long waitlists, geographic disparities, and administrative barriers.
*DRH10581-MGa-149* General Assembly Of North Carolina Session 2025 (8) A coordinated policy framework that prioritizes aging in place when appropriate, strengthens oversight of long-term care settings, supports caregivers and the geriatric workforce, and invests in high-value, person-centered care is necessary to protect older North Carolinians and ensure responsible stewardship of public resources.
*H1138-v-1* General Assembly Of North Carolina Session 2025 (8) A coordinated policy framework that prioritizes aging in place when appropriate, strengthens oversight of long-term care settings, supports caregivers and the geriatric workforce, and invests in high-value, person-centered care is necessary to protect older North Carolinians and ensure responsible stewardship of public resources.
(a) Policy of the State.
(a) Policyof the State.
– It is the policy of the State that individuals aged 55 or older who require long-term services and supports funded in whole or in part by the medical assistance program should receive those services in the most integrated setting appropriate to their needs, consistent with federal law.
– It is the policyof the State that individuals aged 55 or older who require long-term services and supports funded in whole or in part by the medical assistance program should receive those services in the most integrated setting appropriate to their needs, consistent with federal law.
– An individual aged 55 or older may be placed in, or remain in, an institutional long-term care setting, including a nursing facility or a Medicaid-funded adult care home, only upon a documented determination that home- and community-based services are insufficient to meet the individual's assessed clinical, functional, or safety needs.
– An individual aged 55 or older maybe placed in, or remain in, an institutional long-term care setting, including a nursing facility or a Medicaid-funded adult care home, only upon a documented determination that home- and community-based services are insufficient to meet the individual's assessed clinical, functional, or safety needs.
– The Department shall implement this section and may adopt rules and policies necessary to carry out its provisions, including establishing clinical criteria, defining exceptions, and seeking any necessary federal approvals, waivers, or amendments to the Medicaid State Plan." POLYPHARMACY REVIEW FOR MEDICAID BENEFICIARIES RECEIVING LONG-TERM SERVICES AND SUPPORTS SECTION 2.2.
– The Department shall implement this section and may adopt rules and policies necessary to carry out its provisions, including establishing clinical criteria, defining exceptions, and seeking anynecessaryfederal approvals, waivers, or amendments to the Medicaid State Plan." POLYPHARMACY REVIEW FOR MEDICAID BENEFICIARIES RECEIVING LONG-TERM SERVICES AND SUPPORTS SECTION 2.2.
The purpose of this section is Page 2 DRH10581-MGa-149 General Assembly Of North Carolina Session 2025 to reduce preventable harm and unnecessary health care expenditures by ensuring regular, comprehensive medication review for individuals receiving long-term services and supports.
The purpose of this section is Page 2 House Bill 1138-First Edition General Assembly Of North Carolina Session 2025 to reduce preventable harm and unnecessary health care expenditures by ensuring regular, comprehensive medication review for individuals receiving long-term services and supports.
DRH10581-MGa-149 Page 3 General Assembly Of North Carolina Session 2025 (3) Dementia-capable behavioral health interventions designed to address behavioral symptoms without unnecessary reliance on pharmacological treatment.
House Bill 1138-First Edition Page 3 General Assembly Of North Carolina Session 2025 (3) Dementia-capable behavioral health interventions designed to address behavioral symptoms without unnecessary reliance on pharmacological treatment.
(4) Care coordination among primary care providers, behavioral health providers, pharmacists, and long-term services and supports providers.
(4) Care coordination among primarycare providers, behavioral health providers, pharmacists, and long-term services and supports providers.
– TheDepartment may adopt rules to implement this section through clinical policy, managed care contracts, provider standards, care management requirements, or other administrative mechanisms and may prioritize implementation for individuals at highest risk of behavioral health-related hospitalization or institutional placement.
– TheDepartment mayadopt rules to implement this sectionthrough clinical policy, managed care contracts, provider standards, care management requirements, or other administrative mechanisms and may prioritize implementation for individuals at highest risk of behavioral health-related hospitalization or institutional placement.
– TheDepartment may adopt rules to implement this section through clinical policy, care management requirements, managed care contracts, or other administrative Page 4 DRH10581-MGa-149 General Assembly Of North Carolina Session 2025 mechanisms and may prioritize implementation for individuals at higher risk of hospitalization, functional decline, or institutional placement." 4 PART III.
– TheDepartment mayadopt rules to implement this section through clinical policy, care management requirements, managed care contracts, or other administrative Page 4 House Bill 1138-First Edition General Assembly Of North Carolina Session 2025 mechanisms and may prioritize implementation for individuals at higher risk of hospitalization, functional decline, or institutional placement." 4 PART III.
SECTION 3.1.(b) In designing, constructing, and launching the housing-first residential facility for use in the pilot program, the Department of Health and Human Services andanyentityselectedto partnerwiththeDepartmentofHealthandHumanServices shalladhere to all of the following requirements:
SECTION 3.1.(b) In designing, constructing, and launching the housing-first residential facility for use in the pilot program, the Department of Health and Human Services andanyentityselectedto partnerwiththeDepartmentofHealthandHumanServicesshalladhere to all of the following requirements:
(2) Thefacility shall be operatedas housing-first, with residents retaining tenancy rights and receiving health and supportive services through integrated on-site or affiliated providers.
(2) Thefacilityshall be operatedas housing-first, with residents retainingtenancy rights and receiving health and supportive services through integrated on-site or affiliated providers.
(2) Structure the pilot program as a public-private partnership by leveraging both publicand privatesector expertiseand amixtureoffundingsources, including public sector grants, loans provided by public or private institutions or both, and other financing mechanisms.
(2) Structure the pilot program as a public-private partnership by leveraging both publicand privatesector expertiseandamixtureoffundingsources, including public sector grants, loans provided by public or private institutions or both, and other financing mechanisms.
DRH10581-MGa-149 Page 5 General Assembly Of North Carolina Session 2025 (4) Start-up and initial operating costs, including those associated with staffing, care coordination infrastructure, and program launch expenses, as determined necessary by the Department of Health and Human Services.
House Bill 1138-First Edition Page 5 General Assembly Of North Carolina Session 2025 (4) Start-up and initial operating costs, including those associated with staffing, care coordination infrastructure, and program launch expenses, as determined necessary by the Department of Health and Human Services.
(1) Thenumberofresidents andtheirdemographicdata, including,at aminimum, their age and sex.
(1) Thenumberofresidents andtheirdemographicdata,including, at aminimum, their age and sex.
SECTION 3.2.(c) There is appropriated from the General Fund to the Department of Health and Human Services, Division of Aging, Office of the State Long-Term Care Ombudsman, the sum of three million five hundred thousand dollars ($3,500,000) in recurring funds beginning in the 2026-2027 fiscal year to improve the Ombudsman Program as specified Page 6 DRH10581-MGa-149 General Assembly Of North Carolina Session 2025 in subsection (a) of this section and to implement the staffing and regional coverage plan described in subsection (b) of this section.
SECTION 3.2.(c) There is appropriated from the General Fund to the Department of Health and Human Services, Division of Aging, Office of the State Long-Term Care Ombudsman, the sum of three million five hundred thousand dollars ($3,500,000) in recurring funds beginning in the 2026-2027 fiscal year to improve the Ombudsman Program as specified Page 6 House Bill 1138-First Edition General Assembly Of North Carolina Session 2025 in subsection (a) of this section and to implement the staffing and regional coverage plan described in subsection (b) of this section.
(a) The Department of Health and Human Services (DHHS), in consultation with the North Carolina Community Colleges System Office, The University of North Carolina System Office, theNorth Carolina Independent Colleges andUniversities, theDepartment ofCommerce, and relevant licensing boards, shall establish a geriatric workforce pipeline and direct care career advancement program (the program).
(a) The Department of Health and Human Services (DHHS), in consultation with the North Carolina Community Colleges System Office, The University of North Carolina System Office, theNorth Carolina Independent Colleges andUniversities,theDepartment ofCommerce, and relevant licensing boards, shall establish a geriatric workforce pipeline and direct care career advancement program (the program).
DRH10581-MGa-149 Page 7 General Assembly Of North Carolina Session 2025 (3) Establish career ladder models that support advancement from entry-level direct care roles into more specialized or higher-paid roles.
House Bill 1138-First Edition Page 7 General Assembly Of North Carolina Session 2025 (3) Establish career ladder models that support advancement from entry-level direct care roles into more specialized or higher-paid roles.
Page 8 DRH10581-MGa-149 General Assembly Of North Carolina Session 2025 SECTION 3.4.(b) The Department of Health and Human Services, Division of Health Benefits (DHB), is directed to take all actions necessary to support implementation of the pilot program for eligible family caregivers of Medicaid beneficiaries receiving long-term services and supports that meets the requirements of this section, including, as applicable, submitting any necessary documentation to the Centers for Medicare and Medicaid Services (CMS), including State Plan Amendments and waiver amendments.
Page 8 House Bill 1138-First Edition General Assembly Of North Carolina Session 2025 SECTION 3.4.(b) The Department of Health and Human Services, Division of Health Benefits (DHB), is directed to take all actions necessary to support implementation of the pilot program for eligible family caregivers of Medicaid beneficiaries receiving long-term services and supports that meets the requirements of this section, including, as applicable, submitting any necessary documentation to the Centers for Medicare and Medicaid Services (CMS), including State Plan Amendments and waiver amendments.
SECTION 3.4.(f) DHBshall adopt rules orclinical coveragepolicies,as appropriate, establishing guardrails for the pilot program, which may include any of the following:
SECTION3.4.(f) DHBshall adopt rules orclinical coveragepolicies,as appropriate, establishing guardrails for the pilot program, which may include any of the following:
(1) Limits on duplication of payment where the family caregiver is otherwise compensated through another Medicaid service category for the same service.
(1) Limits on duplication of payment where the family caregiver is otherwise compensated through another Medicaid service categoryfor the same service.
DRH10581-MGa-149 Page 9 General Assembly Of North Carolina Session 2025 SECTION 3.4.(h) Nothing in this section shall be construed to create an entitlement to a stipend absent federal approval and an appropriation enacted by the General Assembly.
House Bill 1138-First Edition Page 9 General Assembly Of North Carolina Session 2025 SECTION 3.4.(h) Nothing in this section shall be construed to create an entitlement to a stipend absent federal approval and an appropriation enacted by the General Assembly.
REESTABLISHMENT OF STUDY COMMISSION ON AGING SECTION 4.1.(a) Commission Created;Purpose.
REESTABLISHMENT OF STUDY COMMISSION ON AGING SECTION4.1.(a) CommissionCreated;Purpose.
– Thereis created theAging Study Commission (Commission) for the purpose of studying and recommending legislative and policy changes necessary for North Carolina to respond to the needs of its aging population, particularly as the first wave of the baby boom generation reaches advanced age beginning in 2026.
– Thereis createdtheAgingStudy Commission (Commission) for the purpose of studying and recommending legislative and policy changes necessaryfor North Carolina to respond to the needs of its agingpopulation, particularly as the first wave of the baby boom generation reaches advanced age beginning in 2026.
the persons appointed may be members of the House of Representatives or public members.
the persons appointed maybe members of the House of Representatives or public members.
SECTION 4.1.(d) Meetings.
SECTION4.1.(d) Meetings.
Page 10 DRH10581-MGa-149 General Assembly Of North Carolina Session 2025 SECTION 4.1.(e) Staffing and Assistance.
Page 10 House Bill 1138-First Edition General Assembly Of North Carolina Session 2025 SECTION 4.1.(e) Staffing and Assistance.
– The Commission shall submit a report of its findings and recommendations, including any recommended legislation, to the General Assembly no later than December 31, 2027.
– The Commission shall submit a report of its findings and recommendations, including anyrecommended legislation, to the General Assemblyno later than December 31, 2027.
DRH10581-MGa-149 Page 11
House Bill 1138-First Edition Page 11
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Action History

  1. Passed 1st Reading

  2. Ref to the Com on Appropriations, if favorable, Rules, Calendar, and Operations of the House

  3. Filed

Sponsors

Sponsorship breakdown

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3 sponsors · 41 co-sponsors · 135 not signed on

Sponsors (3)

Co-sponsors (41)

Not signed on (135)

135 members have not signed on to this bill.

Show all 135 →

"Not signed on" means a member has not sponsored or co-sponsored this bill — it does not imply opposition. Members flagged Voted No have a recorded No vote on this bill.

Whip count is in markup. Polling the chamber and every recorded vote this session. Only the first open is slow. It’s instant for you after this. Calling the roll · Tallying · Engrossing

Subjects

housing healthcare labor health-insurance
Cross-referencing the record. Reading this bill against every other bill in the corpus by meaning, not keywords. Only the first open is slow. It’s instant for you after this. Matching · Ranking · Engrossing

Frequently asked questions

Who sponsors HB 1138?
HB 1138 is sponsored by Brian Turner (Democratic), Phil Rubin (Democratic), James Roberson (Democratic), Robert T. Reives, II (Democratic), Amos L. Quick, III (Democratic), Renée A. Price (Democratic), Lindsey Prather (Democratic), Rodney D. Pierce (Democratic), Marcia Morey (Democratic), Nasif Majeed (U), Jordan Lopez (Democratic), Tim Longest (Democratic), Carolyn G. Logan (Democratic), Ya Liu (Democratic), Abe Jones (Democratic), Monika Johnson-Hostler (Democratic), B. Ray Jeffers (Democratic), Zack Hawkins (Democratic), Pricey Harrison (Democratic), Julia Greenfield (Democratic), Allison A. Dahle (Democratic), Sarah Crawford (Democratic), Amanda P. Cook (Democratic), Mike Colvin (Democratic), Bryan Cohn (Democratic), Tracy Clark (Democratic), Maria Cervania (Democratic), Becky Carney (Democratic), Deb Butler (Democratic), Allen Buansi (Democratic), Terry M. Brown Jr. (Democratic), Kanika Brown (Democratic), Mary Belk (Democratic), Amber M. Baker (Democratic), Vernetta Alston (Democratic), Eric Ager (Democratic), Dante Pittman (Democratic), Gloristine Brown (Democratic), Garland E. Pierce (Democratic), Cynthia Ball (Democratic), Beth Helfrich (Democratic), Neal Jackson (Republican), Charles Smith (Democratic), and Julie von Haefen (Democratic).
What is the current status of HB 1138?
This bill is in committee in the House. Introduced April 29, 2026. It must pass committee before a floor vote.
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