Introduction North Carolina has long been a leader in designing and implementing innovative and bipartisan programs that address health care delivery and non-medical drivers of health. Almost 50 years ago, the state created the Sickle Cell Syndrome Program. This program is focused on delivering services to meet the changing needs of sickle cell disease (SCD) patients.1 Ten years ago, the NC Department of Health & Human Services (DHHS) established a pregnancy medical home (PMH) model for Medicaid patients. PMHs deliver care to pregnant and postpartum enrollees in a holistic way that includes non-clinical support such as health management and community services.2 In 2018, NC DHHS’ five-year Healthy Opportunities program was approved through a Centers for Medicare & Medicaid Services (CMS) 1115 Medicaid Waiver. Healthy Opportunities funds projects focused on non-medical drivers of health, such as the nation’s first electronic, statewide directory of organizations connecting health care and human services, called NCCARE360.3 2022 represents a pivotal year for DHHS. DHHS is operating amidst the COVID-19 pandemic, which is disproportionately impacting those with Medicaid and, as we have seen, Black communities.4 On top of the pandemic, NC Medicaid began transitioning the majority of Medicaid enrollees from fee-for-service to Prepaid Health Plans (PHP)—typically called Managed Care Organizations (MCOs) in states with similar models—in July of 2021. PHPs encompass both Standard Plans and Tailored Plans—designed for people with significant behavioral health needs and intellectual/ developmental disabilities—that will launch in December 2022.5 In this report, we will use PHPs when discussing North Carolina Standard Plans and MCOs when discussing other state models.
12 Introduction
NC DHHS officials requested assistance on two health equity-focused policy areas. Specifically, the state Medicaid agency welcomed recommendations on how to design care and payment models for enrollees living with SCD and how to decrease racial and ethnic disparities in maternal health outcomes. While these are two different health experiences, both are marked by glaring racial inequities. One limitation of this report is that NC Medicaid alone cannot adequately address the systematic racism that leads to inequities in SCD and maternal health outcomes. A second limitation is that this report’s scope does not include the Eastern Band of Cherokee Indians Tribal care management plan. As a result, the barriers to care that the North Carolina Indigenous population faces are not addressed. Nevertheless, NC DHHS has the ability to greatly improve the health outcomes and reduce disparities within SCD and maternal health, as this report recommends. This report envisions a North Carolina where Medicaid enrollees face no shortage of providers and can access care without barriers, Medicaid providers are trained to overcome biases in care, and non-medical drivers of health are fully integrated into the health system. Medicaid enrollees with SCD would receive care from medical professionals who understand their community and holistic care needs, have the option of receiving medical care from the comfort of their home, and have access to fundamental SCD services like hydroxyurea, red blood cell molecular testing, and transcranial doppler screenings. Medicaid enrollees who are pregnant would have access to navigators, multiple home visits, and doulas and certified midwives, and those who are postpartum would receive pre-discharge postpartum care plans and depression screenings and treatment.
