Access to Health Insurance

  • Support increased access to affordable health insurance coverage for all North Carolinians through Medicaid expansion. Closing the health insurance coverage gap could provide up to 600,000 uninsured North Carolinians access to the care they need in order to build a stronger, healthier North Carolina.
  • A critical part of any Medicaid expansion bill will be how the State pays for its share of the expansion plan. Hospitals will continue to work with legislators, Governor Cooper and NCDHHS to stress that hospitals should not shoulder the entire amount of the State’s share through an increase of the current hospital assessment tax. Rather, hospitals should only be required to pay for their “fair share” of the costs of expansion through an increase in the hospital assessment tax.
  • Additional Resources

Behavioral Health

  • Support comprehensive access to resources for our behavioral health patients to ensure that they receive the right care at the right time in the right place, regardless of insurance status.
  • Support legislation to fully fund all existing in-patient facilities, including the 3-way bed program for uninsured patients.
  • Support community-based behavioral health services, with an emphasis on early intervention and treatment to address the root causes of inequality for behavioral health patients.
  • Support greater state enforcement of federal behavioral health parity laws that require insurers to cover behavioral health services on par as other covered health benefits, including robust provider networks and equitable reimbursement formulas for providers.
  • Additional Resources

Certificate of Need

  • Support the preservation of the state’s current Certificate of Need law, thereby protecting access to care for medically underserved populations and preventing oversupply that can lead to higher healthcare costs for patients.
  • Support thoughtful modifications to the state’s Certificate of Need law, including elimination of CON for behavioral health and substance abuse/chemical dependency beds and elimination of CON for ASCs in counties with a population in excess of 125,000 in order to reach a compromise to also enact Medicaid expansion and HASP.
  • Additional Resources

Economic Development

  • Support efforts to attract and retain talent in North Carolina, align degree production with workforce needs, and promote innovation and entrepreneurship. Duke is a key partner in state economic development strategies. 

Financial Support for Hospitals

  • Support the Healthcare Access and Stabilization Program (HASP), which would provide hospitals with enhanced Medicaid reimbursements by paying hospitals the difference between their current Medicare equivalent rates and the average commercial rate they would receive for those services.
  • The current Medicaid Program, with a State share primarily funded by assessments on hospitals, reimburses hospitals at Medicare equivalent rates i.e., at cost for services to Medicaid patients. HASP would help hospitals overcome the significant financial liabilities incurred to support those payment levels, unreimbursed costs for uninsured patients, and the significant reimbursement gap for providing safety-net services. The program would be implemented at no cost to the State and would put hospitals in the right financial condition to consider using the hospital assessment tax to pay for the entire State share of Medicaid expansion.
  • Additional Resources

Graduate Medical Education

  • Support maintaining the current state appropriations to graduate medical education and is opposed to any changes to the funding of the existing program that would lead to any decrease or elimination of payments that support Duke’s mission to train medical residents.
  • Support measures to address the state’s current provider shortage through maintaining current medical education programs and expanding access to additional GME funds in more areas of the state.
  • Additional Resources

Higher Education

  • Support the value of higher education in North Carolina by partnering with the 35 other private colleges and universities in North Carolina, as well as the 17 campuses of the UNC system on issues such as workforce development, employment, economic impact, cultural contributions, and other dimensions.

Independent Practice Authority for APRNs

  • Support legislation to allow full-practice authority for nurse practitioners providing primary care.
  • Neutral on legislation that provides full-practice authority for other APRNs including CRNAs, CNMs and CNSs.

Medicaid Transformation / Safety Net Payments

  • Support a transformed Medicaid program that ensures high quality outcomes and provider protections. Duke and other hospitals will continue to work with the legislature and NCDHHS to ensure a smooth transition to Medicaid managed care and resolve claims payment issues that arise.
  • Support a legislative approach that ensures federal dollars earned by health systems flow to those health systems.
  • Oppose the state retention of these funds to ensure providers can recover from the COVID-19 pandemic, plan for future events, and provide care to all, regardless of their insurance status.
  • Additional Resources

Need-based Aid

  • Support legislation that maintains or increases current state appropriation levels for North Carolina’s Need-Based Scholarships for students enrolled in private or independent colleges and universities.

Research Funding

  • Support legislation that provides additional state funding for innovation, discovery, translation and commercialization of research at both public and private universities in North Carolina.
  • Support the current non-profit sales and property tax laws. Duke University and Duke Health are nonprofits that receive certain exemptions under the North Carolina Tax Code. In return for being exempt from certain taxes, non-profit hospitals have a special responsibility to deliver a variety of benefits to serve the needs of their communities. Hospitals report publicly on community benefit activities, which include financial assistance for those in need, as well as a wide range of programs and services designed to meet the current and future health needs of all those they serve. 
  • Opposed any changes to the tax code that would impact Duke University and Duke Health’s status as a nonprofit.


  • Support a legislative and regulatory solution, as well as reimbursement policies, that promote equal access to telehealth services for every North Carolinian in every part of the state.
  • Support protecting patients’ rights for telehealth coverage and expansion of broadband access to bring healthcare to every community.
  • Oppose legislation that restricts access to and discourages insurance coverage of telehealth services. North Carolina is one of the few states that does not currently require insurers to cover and reimburse for telehealth services consistently, and hospitals continue to advocate for policies that incentivize providers to maintain telehealth services as a means to increase access to care.
  • Additional Resources

Transitions of Care/Patient Discharge Issues

  • Support legislative and regulatory changes to assist hospitals with discharging patients to a more appropriate level of care.
  • Support amendments to laws regarding guardianship and child placement issues.

Workforce Development

  • Support comprehensive solutions addressing the entire healthcare workforce pipeline, from preparing tomorrow’s healthcare leaders through world-class education programs to bolstering the resiliency of today’s healthcare workforce with the resources they need to continue providing high-quality care. 
  • Support residency placement programs and loan forgiveness incentives to encourage providers to practice in rural and underserved communities.

Workplace Violence Protections

  • Support legislation that provides additional protections from violence for healthcare workers in clinical settings.