A quarter of a million North Carolinians admit to experiencing opioid use disorder; over 1,000 die each year. Only 1 in 5 receives effective, evidence-based treatment. Medicaid covers treatment and will increase access for members with opioid use disorder, who have been found to fare better than those with private insurance.
{"title":"Lives Worth Saving: The Impact of Medicaid Expansion on Individuals in Recovery","authors":"Kelly Crosbie","doi":"10.18043/001c.94868","DOIUrl":"https://doi.org/10.18043/001c.94868","url":null,"abstract":"A quarter of a million North Carolinians admit to experiencing opioid use disorder; over 1,000 die each year. Only 1 in 5 receives effective, evidence-based treatment. Medicaid covers treatment and will increase access for members with opioid use disorder, who have been found to fare better than those with private insurance.","PeriodicalId":39574,"journal":{"name":"North Carolina Medical Journal","volume":"7 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140235430","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Salama S. Freed, Nicole Frascino, Kelley A Jones, Abhigya Giri, Lucas Stewart, Keren Hendel, Amy G. Clark, Courtney Van Houtven, Aparna Higgins, B. Kaufman
NC Medicaid is amid a transformation to value-based care models. The transformation requires the consideration of models that may best serve the 1 in 5 NC Medicaid beneficiaries who are dually enrolled in Medicare. The lack of integration of Medicare and Medicaid administration, financing, and care may contribute to suboptimal health outcomes and care experiences. Integrating Medicare and Medicaid to improve care for dually enrolled individuals requires knowledge of the demographic, eligibility, and enrollment trends, as well as the medical needs of these individuals throughout North Carolina. We performed a cross-sectional analysis of 2019 NC Medicaid administrative enrollment data and 2015–2020 Medicare and Medicaid public use files. Nearly half of North Carolina’s full-benefit dual-eligible (FBDE) population was eligible for Medicare due to disability. About one-third of the FBDE population lost full Medicaid benefits at some point during 2019; of these, 65% were under age 65. Most FBDE beneficiaries were enrolled in Medicaid fee-for-service, with 3.5% enrolled in Community Alternatives Program (CAP) waivers, 2% in Medicaid waivers for beneficiaries with behavioral health or intellectual and developmental disabilities (BH/IDD) or traumatic brain injury (TBI), and 1% in the Program of All-Inclusive Care for the Elderly (PACE). Enrollment in Medicare Duals Special Needs Plans (D-SNPs) increased from 7.3% of the FBDE population in 2015 to 32.5% in 2021. This descriptive, cross-sectional evaluation of North Carolina duals may not be generalizable to other time periods and contexts. Medicare-Medicaid integration presents an opportunity to improve the value of care for dual-eligible beneficiaries and aligns with the goals of NC Medicaid transformation. Integration strategies that leverage the current infrastructure may minimize disruption of services for beneficiaries and mitigate the impacts of unstable enrollment, particularly among working-age adults and disabled beneficiaries. The diversity within the dual-eligible populations requires a strategy designed to improve health equity across race, disability, eligibility, geography, and health care needs.
{"title":"Opportunities for Integration in the Dual Medicare-Medicaid Population: North Carolina Landscape Analysis","authors":"Salama S. Freed, Nicole Frascino, Kelley A Jones, Abhigya Giri, Lucas Stewart, Keren Hendel, Amy G. Clark, Courtney Van Houtven, Aparna Higgins, B. Kaufman","doi":"10.18043/001c.94879","DOIUrl":"https://doi.org/10.18043/001c.94879","url":null,"abstract":"NC Medicaid is amid a transformation to value-based care models. The transformation requires the consideration of models that may best serve the 1 in 5 NC Medicaid beneficiaries who are dually enrolled in Medicare. The lack of integration of Medicare and Medicaid administration, financing, and care may contribute to suboptimal health outcomes and care experiences. Integrating Medicare and Medicaid to improve care for dually enrolled individuals requires knowledge of the demographic, eligibility, and enrollment trends, as well as the medical needs of these individuals throughout North Carolina. We performed a cross-sectional analysis of 2019 NC Medicaid administrative enrollment data and 2015–2020 Medicare and Medicaid public use files. Nearly half of North Carolina’s full-benefit dual-eligible (FBDE) population was eligible for Medicare due to disability. About one-third of the FBDE population lost full Medicaid benefits at some point during 2019; of these, 65% were under age 65. Most FBDE beneficiaries were enrolled in Medicaid fee-for-service, with 3.5% enrolled in Community Alternatives Program (CAP) waivers, 2% in Medicaid waivers for beneficiaries with behavioral health or intellectual and developmental disabilities (BH/IDD) or traumatic brain injury (TBI), and 1% in the Program of All-Inclusive Care for the Elderly (PACE). Enrollment in Medicare Duals Special Needs Plans (D-SNPs) increased from 7.3% of the FBDE population in 2015 to 32.5% in 2021. This descriptive, cross-sectional evaluation of North Carolina duals may not be generalizable to other time periods and contexts. Medicare-Medicaid integration presents an opportunity to improve the value of care for dual-eligible beneficiaries and aligns with the goals of NC Medicaid transformation. Integration strategies that leverage the current infrastructure may minimize disruption of services for beneficiaries and mitigate the impacts of unstable enrollment, particularly among working-age adults and disabled beneficiaries. The diversity within the dual-eligible populations requires a strategy designed to improve health equity across race, disability, eligibility, geography, and health care needs.","PeriodicalId":39574,"journal":{"name":"North Carolina Medical Journal","volume":"174 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140235594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Shannon Dowler, Julia Lerche, Melanie Luques, Matthew Nash, Sam Thompson, Janelle White
The North Carolina Department of Health and Human Services plans to utilize a data-driven approach to evaluate the impacts of Medicaid expansion in the state. The evaluation plan includes tracking enrollment counts, creating metrics for monitoring of activities, setting measurable goals, and involving trusted community partners throughout.
{"title":"Shared Success: Developing a Plan to Evaluate the Implementation and Impact of Medicaid Expansion in North Carolina","authors":"Shannon Dowler, Julia Lerche, Melanie Luques, Matthew Nash, Sam Thompson, Janelle White","doi":"10.18043/001c.94845","DOIUrl":"https://doi.org/10.18043/001c.94845","url":null,"abstract":"The North Carolina Department of Health and Human Services plans to utilize a data-driven approach to evaluate the impacts of Medicaid expansion in the state. The evaluation plan includes tracking enrollment counts, creating metrics for monitoring of activities, setting measurable goals, and involving trusted community partners throughout.","PeriodicalId":39574,"journal":{"name":"North Carolina Medical Journal","volume":" 46","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140391013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jessica Kuhn, Sam Thompson, Hannah Fletcher, Tess Koenigsmark, Shannon Dowler
Telehealth was instrumental in NC Medicaid’s ability to provide health care during the COVID-19 pandemic. Analyses of utilization and survey data and interviews with key Medicaid payors and providers reveal trends in beneficiary access to and utilization of services, presenting NC Medicaid with opportunities to build upon lessons learned.
{"title":"NC Medicaid’s Telehealth Evolution: Access and Utilization in a Post-Pandemic State","authors":"Jessica Kuhn, Sam Thompson, Hannah Fletcher, Tess Koenigsmark, Shannon Dowler","doi":"10.18043/001c.94867","DOIUrl":"https://doi.org/10.18043/001c.94867","url":null,"abstract":"Telehealth was instrumental in NC Medicaid’s ability to provide health care during the COVID-19 pandemic. Analyses of utilization and survey data and interviews with key Medicaid payors and providers reveal trends in beneficiary access to and utilization of services, presenting NC Medicaid with opportunities to build upon lessons learned.","PeriodicalId":39574,"journal":{"name":"North Carolina Medical Journal","volume":"28 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140235170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Medicaid Flexibilities in Action: North Carolina Member Testimonials","authors":"Shannon Dowler","doi":"10.18043/001c.94871","DOIUrl":"https://doi.org/10.18043/001c.94871","url":null,"abstract":"","PeriodicalId":39574,"journal":{"name":"North Carolina Medical Journal","volume":"63 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140235007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kim A. Schwartz, Leslie Wolcott, Erica Powell, Pamela Tripp
{"title":"Changes on the Ground: Dispatches on Medicaid Expansion from Two North Carolina Federally Qualified Health Centers","authors":"Kim A. Schwartz, Leslie Wolcott, Erica Powell, Pamela Tripp","doi":"10.18043/001c.94874","DOIUrl":"https://doi.org/10.18043/001c.94874","url":null,"abstract":"","PeriodicalId":39574,"journal":{"name":"North Carolina Medical Journal","volume":"2 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140235215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Arianna Keil, Ryan Fair, Wendy Qi, Sam Thompson, Shannon Dowler
A quarter of a million North Carolinians admit to experienc¬ing opioid use disorder; over 1,000 die each year. Only 1 in 5 receives effective, evidence-based treatment. Medicaid covers treatment and will increase access for members with opioid use disorder, who have been found to fare better than those with private insurance.
{"title":"NC Medicaid’s Early Experience with a Hospital at Home Program During the Public Health Emergency","authors":"Arianna Keil, Ryan Fair, Wendy Qi, Sam Thompson, Shannon Dowler","doi":"10.18043/001c.94869","DOIUrl":"https://doi.org/10.18043/001c.94869","url":null,"abstract":"A quarter of a million North Carolinians admit to experienc¬ing opioid use disorder; over 1,000 die each year. Only 1 in 5 receives effective, evidence-based treatment. Medicaid covers treatment and will increase access for members with opioid use disorder, who have been found to fare better than those with private insurance.","PeriodicalId":39574,"journal":{"name":"North Carolina Medical Journal","volume":"31 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140235365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
During the COVID-19 pandemic, people who may have otherwise lost Medicaid coverage kept it without the need to reapply annually. In 2023, this continuous coverage began to unwind just as North Carolina prepared to expand Medicaid. This issue of the North Carolina Medical Journal tracks the evolution of the state’s public payer landscape in unprecedented times of change, with data, analysis, and personal experiences from public health, philanthropy, clinicians, and Medicaid members.
{"title":"From Continuous Coverage to Medicaid Expansion: North Carolina’s Changing Public Payer Landscape","authors":"Shannon Dowler","doi":"10.18043/001c.94840","DOIUrl":"https://doi.org/10.18043/001c.94840","url":null,"abstract":"During the COVID-19 pandemic, people who may have otherwise lost Medicaid coverage kept it without the need to reapply annually. In 2023, this continuous coverage began to unwind just as North Carolina prepared to expand Medicaid. This issue of the North Carolina Medical Journal tracks the evolution of the state’s public payer landscape in unprecedented times of change, with data, analysis, and personal experiences from public health, philanthropy, clinicians, and Medicaid members.","PeriodicalId":39574,"journal":{"name":"North Carolina Medical Journal","volume":"66 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140235158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In March 2020, the COVID-19 public health emergency compelled NC Medicaid to implement Appendix K flexibilities to change the 1915(c) Home & Community-Based Services Waivers. This paper will examine the impact of these flexibilities and the subsequent decision to sunset them, with a focus on the Innovations Waiver.
2020 年 3 月，COVID-19 公共卫生紧急事件迫使北卡罗来纳州医疗补助计划实施附录 K 灵活措施，以改变 1915（c）家庭和社区服务豁免。本文将以 "创新 "豁免为重点，探讨这些灵活性的影响以及随后做出的取消这些灵活性的决定。
{"title":"Impact on Appendix K Flexibilities in the NC Innovations Waiver During the COVID-19 Public Health Emergency","authors":"Deb Goda, LaCosta Parker","doi":"10.18043/001c.94870","DOIUrl":"https://doi.org/10.18043/001c.94870","url":null,"abstract":"In March 2020, the COVID-19 public health emergency compelled NC Medicaid to implement Appendix K flexibilities to change the 1915(c) Home & Community-Based Services Waivers. This paper will examine the impact of these flexibilities and the subsequent decision to sunset them, with a focus on the Innovations Waiver.","PeriodicalId":39574,"journal":{"name":"North Carolina Medical Journal","volume":"4 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140235444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In March 2022, the North Carolina Department of Health and Human Services launched a first-in-the-nation program, the Healthy Opportunities Pilots, to reimburse for evidence-based, non-medical services through Medicaid. This article reflects on nearly two years of the pilot, including early findings and lessons learned to date.
{"title":"Reflecting on Nearly Two Years of North Carolina’s Healthy Opportunities Pilots","authors":"Amanda Van Vleet","doi":"10.18043/001c.94844","DOIUrl":"https://doi.org/10.18043/001c.94844","url":null,"abstract":"In March 2022, the North Carolina Department of Health and Human Services launched a first-in-the-nation program, the Healthy Opportunities Pilots, to reimburse for evidence-based, non-medical services through Medicaid. This article reflects on nearly two years of the pilot, including early findings and lessons learned to date.","PeriodicalId":39574,"journal":{"name":"North Carolina Medical Journal","volume":"152 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140235636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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