This bulletin applies to both NC Medicaid Direct and NC Medicaid Managed Care.
H.R.1 (Pub. L. No. 119-21) was signed into law on July 4, 2025, by President Trump. H.R.1 prohibits Medicaid payments to certain prohibited entities for one year, effective July 4, 2025. This provision was temporarily blocked from implementation by a Federal District Court Judge, who issued a temporary restraining order (TRO) effective through July 21, 2025. This TRO only applied to Planned Parenthood.
The most recent court order issued on July 21, 2025, does not apply to NC Planned Parenthood entities (Planned Parenthood South Atlantic) based on claims payments made in 2023.
H.R.1 defined these prohibited entities as follows:
The term ‘‘prohibited entity’’ means an entity, including its affiliates, subsidiaries, successors, and clinics —
- (A) that, as of the first day of the first quarter beginning after the date of enactment of this Act —
- (i) is an organization described in section 501(c)(3) of the Internal Revenue Code of 1986 and exempt from tax under section 501(a) of such Code;
- ii) is an essential community provider described in section 156.235 of title 45, Code of Federal Regulations (as in effect on the date of enactment of this Act), that is primarily engaged in family planning services, reproductive health, and related medical care; and
- (iii) provides for abortions, other than an abortion —
- (I) if the pregnancy is the result of an act of rape or incest; or
- (II) in the case where a woman suffers from a physical disorder, physical injury, or physical illness, including a life-endangering physical condition caused by or arising from the pregnancy itself, that would, as certified by a physician, place the woman in danger of death unless an abortion is performed; and
- (B) for which the total amount of Federal and State expenditures under the Medicaid program under title XIX of the Social Security Act for medical assistance furnished in fiscal year 2023 made directly, or by a covered organization, to the entity or to any affiliates, subsidiaries, successors, or clinics of the entity, or made to the entity or to any affiliates, subsidiaries, successors, or clinics of the entity as part of a nationwide health care provider network, exceeded $800,000.
At this time, NC Medicaid-enrolled organizations with the legal name “Planned Parenthood South Atlantic” are impacted by this provision.
- These providers may continue to receive payment from NC Medicaid for services rendered with Dates of Service (DOS) through July 21, 2025.
- NC Medicaid payments will cease for identified prohibited entities.
- NC Medicaid will automatically reprocess and recoup any paid claims for DOS on or after July 22, 2025, that are not in compliance with this provision.
Impacted providers should work with their NC Medicaid members to support transition to other providers for care. Providers and beneficiaries may use the NC Medicaid Provider and Health Plan Lookup Tool to explore options in their area.
NC Medicaid understands that this situation is rapidly evolving and will continue to monitor any changes as it relates to this provision.
NC Medicaid is committed to maintaining access to health services for Medicaid beneficiaries while also complying with all applicable federal requirements. NC Medicaid appreciates your ongoing partnership.
Contact
NCTracks Call Center: 1-800-688-6696
For questions related to NC Medicaid Managed Care, contact the health plans for more information. Contact information is available on the Health Plan Contacts and Resources webpage.