As Americans, many people are raised with the hopes of pursuing their dreams in whatever form they take. Yet, many individuals find that hope to be unattainable due to poor health. For some, health care expenses are simply too great for their budget. For others, poor health prevents them from holding or maintaining employment.
Thankfully, three years ago North Carolina developed a new way to improve the health of many individuals across our state through the launch of Medicaid managed care. Building on the strong foundation of managed care, the state expanded Medicaid eligibility in 2023 to ensure that more individuals in financially challenging situations have access to quality health care through this program at no cost to the state.
Medicaid, as a federal health-insurance program administered by the state, provides health coverage for individuals and families up to a specific level of income. The Medicaid managed care program better serves both patients and the state over the traditional Medicaid delivery model. It is simply a win-win for all involved.
Most importantly, in the Medicaid managed care model, patients receive more tailored services that meet their specific healthcare needs. This patient-centered model gives people a primary care doctor who understands a person’s specific needs, which leads to improved health and improved use of the health care system. Patients are also afforded the dignity of choosing their Medicaid health plan based on their specific health care and life situation needs. Plans differentiate themselves by offering additional and unique benefits for their members, such as transportation, wellness benefits, and educational supports.
North Carolina’s Medicaid health plans are also highly focused on addressing the non-medical factors that can affect people’s health. Health is impacted by one’s life situation in addition to physical challenges. Social determinants of health (SDOH) such as transportation, access to quality food, housing, and exposure to violence or toxic stress all influence health outcomes. By understanding a patient’s individual circumstances, a care manager can ensure their patients get to appointments, take appropriate medications, and monitor challenging health care conditions. In each situation, a plan may take extraordinary measures, such as home modifications, to ensure that their patients have everything they need to ensure their wellbeing. These additional services were not available prior to Medicaid managed care.
One health plan, for example, serves a member who had issues getting to and from doctors’ appointments and treatments — the driveway leading to the house made it impossible for vehicles to access the front door. The plan paid to have the driveway repaired to create an access for medical transportation and emergency vehicles.
While patients will experience a greater quality of health and life in Medicaid managed care, North Carolina also receives a significant benefit: budget certainty. The Medicaid health plans are given a set amount of funds based on the enrollees they manage and must manage their care within that set budget. Plans are incentivized to improve health care outcomes with specific measurements including increased vaccination rates and ensuring pregnant members access services. These incentives have a dual benefit: they ultimately improve the health of their members and reduce costs for the health care system. As patients better utilize the health care system and chronic conditions are managed, costs decrease. If the goal is to both improve the health of North Carolinians and the fiscal health of the state, Medicaid managed care is proving to be a success on both fronts.
Medicaid managed care is a proven way to improve the health and, therefore, the quality of life, of people across our country. North Carolina’s managed care program, its approach to Medicaid expansion, and its implementation of both is a model for the nation — and our citizens are the beneficiaries.
Through Medicaid managed care plans, North Carolinians have better access to quality and more-targeted health care, which leads to an increased ability to pursue their life dreams. Good health is essential to our ability to be productive and engage in our families and communities, and ultimately to pursue the American dream. Thanks to the leadership from our legislators and the NC Department of Health and Human Services in making Medicaid managed care a reality, our citizens have better opportunity to lead a fulfilling life.
