SB 402 – Close the Medicaid Coverage Gap

Primary Senate Sponsors: Sen. Gladys Robinson (D-Guilford); Sen. Ben Clark (D-Cumberland, Hoke)




This bill:

  • Deems individuals part of the Medicaid coverage gap and eligible for Medicaid benefits if all of the following requirements are met: (1) the individual has a modified adjusted gross income that is at or below 133% of the federal poverty level; (2) the individual is between the ages of 19 and 65; (3) the individual is not entitled to or enrolled in Medicare benefits under part A or Part B of Title XVIII of the federal Social Security Act; and (4) the individual is not otherwise eligible for Medicaid coverage as it existed on January 1, 2020.
  • Requires DHHS to provide benefits to eligible beneficiaries in the Medicaid coverage gap through an Alternative Benefit Plan unless that beneficiary is exempt from mandatory enrollment under federal law.
  • Requires copayments for benefits provided under the Alternative Benefit Plan to be the same as copayments required for Medicaid beneficiaries not under the Plan.
  • Requires DHHS to provide coverage for individuals deemed to be part of the Medicaid coverage gap.
  • Provides that the cost associated with providing coverage to qualified individuals in the Medicaid coverage gap shall be funded with federal funds received under the American Rescue Plan Act of 2021.


Filed – 3/30/2021