Sen. Alexander files bill in North Carolina Senate to revise Medicaid eligibility rules

A new bill filed by State Sen. Alexander seeks to align North Carolina’s Medicaid eligibility rules with federal law to protect seniors transferring assets into special needs trusts, according to the North Carolina State Senate.

The bill, filed as SB 344 on March 19 during the 2025 regular session, was formally listed with the short title: ‘Pooled Trust Transfers/Public Benefits Elig.’

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

In essence, this bill mandates the North Carolina Department of Health and Human Services to revise its Medicaid and State-County Special Assistance eligibility rules for individuals 65 and older. It ensures that transferring assets into a pooled special needs trust, compliant with federal guidelines, is considered a fair market value transfer, thereby not affecting eligibility for these benefits. The transferred funds must be intended for use by the trustee to provide goods and services equal to the funds’ fair market value within the individual’s life expectancy. The changes align state policies with federal law to prevent financial penalties for such asset transfers by seniors. The act becomes effective upon enactment.

Of the three sponsors of this bill, Amy S. Galey proposed the most bills (26) 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.

Alexander graduated from the University of North Carolina at Charlotte with a BA.

Alexander, a Republican, was elected to the North Carolina State Senate in 2019 to represent the state’s 44th Senate district, replacing previous state senator Vickie Sawyer.