Supporting Integration of Medicare and Medicaid in North Carolina

Overview:

North Carolina (NC) is in the midst of a major shift from fee-for-service (FFS) to Medicaid managed care and other value-based care transformation efforts. Scheduled to go live July 1, 2021, the state will use Prepaid Health Plan (PHP) managed care contracts for Medicaid-only beneficiaries. PHPs are envisioned to provide and manage comprehensive physical health, behavioral health, and long-term services and supports (LTSS) for Medicaid-only enrollees under a single capitated rate.

As part of its care transformation efforts, North Carolina Department of Health and Human Services (NC DHHS) is keenly interested in developing options to integrate care for individuals who are dually eligible for Medicare and Medicaid. In 2019, 12 million beneficiaries nationwide were either fully or partially enrolled in both Medicare and Medicaid, with over 300,000 in North Carolina. However, only about one million dually eligible beneficiaries in the US are enrolled in programs designed to better integrate Medicare and Medicaid. Dually eligible beneficiaries have complex medical and psycho-social needs. The lack of integration has led to suboptimal access to care, poor outcomes, and a lack of seamless experiences with the care delivery system. Despite concerted federal and state efforts, only about a third of the states have integrated care for dually eligible beneficiaries.

In 2017, NC released a legislatively mandated strategy paper outlining potential approaches for integration. The strategy paper left many questions central to program design unanswered, including those pertaining to eligibility, structure, and phase-in of benefits and services.
 

Objectives:

Working in collaboration with NC DHHS, and with support from Arnold Ventures and the Center for Health Care Strategies, the Duke-Margolis Center for Health Policy will develop policy options for Medicare-Medicaid integration in NC and prepare a practical planning guide that can be used by other states seeking to achieve similar objectives.

Approach:

We plan to use a phased, multi-component approach to develop the policy options:

• Convening an Advisory Panel of national and state experts in Medicare-Medicaid integration, engaging NC DHHS, and soliciting input and perspectives from key NC stakeholders who could be affected by proposed changes
• Completing a mixed methods study that includes interviews with relevant stakeholders and analyses of a newly linked Medicaid and Medicare fee-for-service dataset of the NC dually eligible  population.

The project will also be completed in two phases:

• Phase 1 (2021): Gathering expert advisory panel insights at two meetings, carrying out a rapid literature review, conducting stakeholder interviews with an emphasis on NC engagement, and data curation and preparation.
• Phase 2 (2022): Data analysis and broad NC stakeholder engagement to refine the policy options and to obtain stakeholder buy-in of the policy vision.