North Carolina Medicaid’s transition to risk-based managed care: findings from the preimplementation period
- Collection:
- Health Policy and Services Research
- Series Title(s):
- Urban Institute research report
- Author(s):
- Allen, Eva H., author Johnston, Emily (Emily M.), author Courtot, Bridgette, author Alvarez Caraveo, Clara, author Gonzalez, Dulce, author Long, Julia, (Of Urban Institute), author
- Contributor(s):
- Health Policy Center (Urban Institute), issuing body. Urban Institute, issuing body.
- Publication:
- Washington, DC : Urban Institute, April 2022
- Language(s):
- English
- Format:
- Text
- Subject(s):
- Health Equity -- economics Health Policy Managed Care Programs -- statistics & numerical data Medicaid -- economics Social Mobility North Carolina United States
- Genre(s):
- Technical Report
- Abstract:
- The North Carolina legislature passed a law in 2015 formally directing the state’s Department of Health and Human Services (DHHS) to implement a risk-based managed care delivery system for Medicaid and the Children’s Health Insurance Program (CHIP). DHHS announced its plan for Medicaid transformation in 2018. In addition to moving from a fee-for-service (FFS) approach to a risk-based managed care approach, the plan includes measures to better integrate physical and behavioral health care delivery and address social determinants of health. In July 2021, after several delays related to the state budget process and the COVID-19 pandemic, almost 1.6 million Medicaid beneficiaries were transitioned to managed care and enrolled in prepaid health plans (PHPs), including most parents and children, pregnant women, and non-Medicare Aged, Blind, and Disabled populations. The Urban Institute, with funding from the Kate B. Reynolds Charitable Trust, is examining North Carolina Medicaid’s transition to managed care and its effects on equitable health outcomes for North Carolinians, focusing on the effects of Medicaid transformation on access to and quality of care for children and pregnant and parenting people. This mixed-methods study includes a qualitative component consisting of interviews with key stakeholders involved in or affected by the implementation of managed care, as well as focus groups with Medicaid beneficiaries. Initial interviews and focus groups were conducted in spring and summer 2021 while preparations for the managed care launch were under way, to learn about the strengths and weaknesses of the precursor FFS system, implementation progress, and expectations of how the managed care system may affect access to and quality of care and health disparities. Data collection occurred during the PHP open enrollment period just before the launch of managed care and during the COVID-19 pandemic. As such, our findings offer a unique insight into the experiences of a broad range of Medicaid stakeholders during a transitional time for the program and an unprecedented public health crisis. Below, we summarize key findings by topic.
- Copyright:
- Reproduced with permission of the copyright holder. Further use of the material is subject to CC BY-NC-DC license. (More information)
- Extent:
- 1 online resource (1 PDF file (viii, 37 pages)).
- NLM Unique ID:
- 9918486682806676 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/9918486682806676