Generating Evidence-Based Recommendations for Advancing Access to High Quality, Whole-Person Care in NC Medicaid

Overview

Improving access to health and social care is foundational to narrowing systemic inequities in health outcomes during the continued implementation of managed care in North Carolina. At the same time, federal and state-level Medicaid policy reforms are rapidly evolving, prompting a need for responsive, practical evaluation and guidance around these budgetary and operational changes. Recognizing this context, our project broadly aims to identify and address disparities in access to care within NC Medicaid. Minimal research exists to establish a comprehensive understanding of access to care within NC Medicaid, making this a key space to focus on. Through our research, we will center consumer voices; identify disparities in access, use, cost, and outcomes; and propose strategies to ensure all NC Medicaid members have access to whole-person, family-centered health and social care.

A primary focus area is examining existing network adequacy standards, which are one way access to care is measured in the state. However, these standards may not reflect “realized” access, particularly for behavioral health and specialty care, or in rural or underserved areas. Based on findings from our previous research and input from North Carolina Stakeholders, considering other ways to assess and improve access to care is a priority. We will be using a mixed-methods approach that includes quantitative analysis of Medicaid health care claims data and other sources to better understand access in NC Medicaid. This will be coupled with qualitative research—informed by our quantitative findings—to better understand the experiences of NC Medicaid members and providers. Based on our research findings, we will develop evidence-based, actionable policy guidance to be leveraged by policymakers, providers, advocates, and community members.

Funding

Funding for this project is provided by the Kate B. Reynolds Charitable Trust.

Key Findings

We will disseminate our findings through multiple channels, including deliverables synthesizing our qualitative and quantitative research findings and summarizing policy reform considerations. We also plan to distribute the information through fact sheets containing key findings tailored to specific populations, along with presentations to research, policy, and community groups to support policy change.