Health policy experts: Medicaid expansion, program changes have helped NC patients and providers

Yahoo

2 days ago

Patients have their blood pressure checked and other vitals taken at a mobile dental and medical clinic in Grundy, Va. Republicans in Congress are considering making major cuts to Medicaid. ()
Medicaid managed care in North Carolina has resulted in fewer 'preventable admissions' to hospitals — hospitalizations for certain conditions that can be prevented with good outpatient care, according to a UNC researcher.
'We're talking about real money that's being saved through this change in utilization,' said Sandra B. Greene, professor of the practice of health policy at the Gillings School of Global Public Health at UNC. 'This is fantastic news.'
After the state expanded Medicaid, hospitals saw a decline in uninsured patients, Greene said. That means hospitals are now treating fewer people for whom they don't receive payment, she said.
Researchers, community advocates, and policy makers saw an overview of how the rapid changes to Medicaid in North Carolina over the last few years have altered the health care landscape at a symposium hosted by the Sheps Center for Health Services Research at UNC and the NC Department of Health and Human Services on Friday.
The state switched to Medicaid managed care for most enrollees in July 2021. That means that companies receive a certain amount of money per Medicaid enrollee and that health care providers are no longer paid for each medical procedure under a system called fee-for-service.
The state expanded Medicaid to add more low-income adults in December 2023. Since its launch, more than 600,000 people have enrolled in expanded Medicaid.
About 3 million North Carolinians use Medicaid as their health insurance.
Rural residents disproportionately rely on Medicaid for their insurance, and many rural hospitals struggle financially.
One of the arguments for Medicaid expansion was the opportunity it offered to strengthen rural hospital finances. Data from the first six months of expansion found that's what happened, said Mark Holmes, Sheps Center director.
'Expansion led to a substantial increase in revenue for all hospitals, more so in rural, and more so for the financially challenged hospitals,' Holmes said.
More Medicaid changes may be coming. A giant bill that passed the U.S. House includes work requirements for Medicaid enrollees. North Carolina Republicans are also actively considering work requirements. The state Senate passed a bill on Medicaid work requirements and included a work requirements provision in its budget. A state House committee has approved a work requirements bill.
Work requirements have been criticized because they have been found to not increase employment but to result in working people losing their insurance.
Susie Gurzenda, a doctoral student at Gillings, presented results of research on the work status of North Carolina adults before Medicaid expansion that showed 42% were working full time or part time; 26% were not working due to illness or disability; 10% had children; 5% were in school; 4% were looking for jobs; and 10% not working for some other reason.
DHHS is trying to save a project it launched in three mostly rural regions of the state in 2022 called Healthy Opportunities. It aims to lower health care costs and improve the health of Medicaid enrollees by helping them secure food, transportation, and housing, and help those experiencing interpersonal violence.
Healthy Opportunities saved $85 per person per month in health care costs, according to an evaluation by Dr. Seth Berkowitz, an associate professor at the UNC School of Medicine.
Neither the House nor the Senate budget proposals include money to continue and expand Healthy Opportunities, though three legislators who attended the symposium said they were interested in it.
The lack of Healthy Opportunities funding in the budget 'has been a huge concern of mine,' said Rep. Sarah Crawford (D-Wake).
'People are healthier because of Medicaid expansion,' she said. 'We have more work to do.'
Rep. Tim Reeder (R-Pitt), an emergency physician, said he sees value in Healthy Opportunities, and has talked with DHHS about 'how we can continue to demonstrate the value of the program.'
'I think, right now, we're just trying to find sources of revenue to help continue the program,' said Reeder, a chairman of the House Health Committee.
Sen. Jim Burgin (R-Harnett), a chairman of the Senate Health Committee and of the chamber's Health and Human Services budget committee, said he wants money for Health Opportunities, but raised the question whether House and Senate Republicans would agree on any spending plan for next year.
The two chambers' budgets differ greatly on proposed taxation and spending. The two chambers must reach a compromise before sending a budget to Gov. Josh Stein for his consideration.
'We're far apart,' Burgin said. 'Somebody asked me yesterday, 'Will we have a budget?' I don't know. It's the furthest apart I've ever seen it in my time.'