Includes whereas clauses.

Repeals Section 3 of SL 2013-5, which prohibited the expansion of the State's Medicaid eligibility.

Requires the Department of Health and Human Services (DHHS), Division of Medical Assistance (Division), to, beginning January 1, 2019, provide Medicaid coverage to all people under age 65 who have incomes equal to or less than 133% of the federal poverty guidelines. Specifies that the medical assistance provided to persons in this Affordable Care Act expansion group is to consist of the coverage described in 42 USC § 1396a(k)(1).

States the General Assembly's intent to utilize the Medicaid Expansion Assessment under new GS 108A‑131, as well as savings to other State programs as reflected in this act to pay for the State share of costs associated with Medicaid expansion.

Appropriates $17,395,164 in recurring funds for the 2018‑19 fiscal year  from the General Fund to the Division to pay for administrative costs associated with Medicaid expansion. Specifies that these funds provide a State match for the specified amount in federal funds and provides that those federal funds are appropriated to pay for administrative costs associated with Medicaid expansion. Provides that if the amount of federal funds available to pay for administrative costs associated with Medicaid expansion exceeds the amounts set out in the act, then the expenditure of State funds must be reduced by an amount equal to the amount of available excess federal funds, and appropriates those excess federal funds for the described purposes. 

Appropriates $143,504,770 in recurring funds for 2018‑19 from the Division to pay for service costs associated with Medicaid expansion. Appropriates $10,170,992 in recurring funds for 2018‑19 from the General Fund to the Division to pay for service costs associated with Medicaid expansion. Specifies that these funds provide a State match for the specified amount in federal funds and provides that those federal funds are appropriated to pay for service costs associated with Medicaid expansion.

Provides that if the amount of federal funds available to pay for service costs associated with Medicaid expansion exceeds the amounts set out in the act, then the expenditure of State funds must be reduced by an amount equal to the amount of available excess federal funds, and appropriates those excess federal funds for the described purposes.

Reduces the appropriation to DHHS, Division of Mental Health, Developmental Disabilities, and Substance Abuse Services, by $10,170,992 in recurring funds for 2018‑19 because of the savings generated by the expansion.

Reorganizes the statutes in the Hospital Assessment Act (GS Chapter 108A, Article 7) under specified parts.

Enacts new GS 108A-131 to make each hospital that is not fully exempt from both the equity assessment and UPL assessment under GS 108A‑122(c) subject to an additional assessment. Requires the Secretary of Health and Human Services (Secretary) to calculate the assessment amount for a hospital annually by multiplying the total state share of service and administrative costs, net of savings to other state programs, of Medicaid expansion by the hospital provider's percentage of all Medicaid services billed by all hospitals subject to the statute. Requires the Secretary to notify each hospital that is assessed of the: (1) total State share of service and administrative costs of Medicaid expansion for the applicable time period, (2) hospital's share of all Medicaid services billed, and (3) amount assessed to the hospital. Specifies that the assessment is in addition to and has greater priority than any assessment that might be collected from a hospital provider under Part 2 (UPL and Equity Assessments) of this Article and sets out requirements for when federal limitations on the total amount of Medicaid assessments that may be collected require the State to reduce the amount of assessments collected. Allows a hospital to appeal an assessment determination through a reconsideration review. 

Amends GS 108A‑124 to make conforming changes.

Effective July 1, 2018.