Maternal Health-Specific Transportation NC Medicaid should require PHPs to provide NEMT tailored specifically to pregnant and postpartum women. Specifically, NC DHHS should require PHPs and NEMT brokers to allow enrollees to bring their children, and possibly an adult attendant if needed, to their appointments in all cases. This policy should be clearly communicated to enrollees. For an approach even more tailored to pregnant and postpartum women, NC Medicaid could require or incentivize PHPs and their NEMT brokers to provide a dedicated vehicle to transport groups of pregnant and postpartum women directly to their appointments without waiting for other enrollees to complete their appointments. This is a relatively short-term solution which can be implemented by updating PHP contracts.
3. Provider Bias Training NC DHHS should expand and improve its implicit bias training requirements to include perinatal and SCD providers. Implementation: • NC DHHS should convene a working group to recommend an approach for expanding and improving implicit bias training. North Carolina Context
Implicit bias in the health care system is a serious barrier for patients of color receiving the care they need. Although the state already requires PHP staff to undergo equity and implicit bias training, stakeholder interviews revealed that implicit bias training is a critical need for North Carolina.122 The North Carolina Institute of Medicine’s 2020 “Healthy Moms, Healthy Babies” report, which proposed recommendations to reduce infant and maternal mortality and morbidity in the state and address racial disparities, discussed implicit bias as a key factor that contributes to health disparities. Similarly, a needs assessment survey of ED providers in North Carolina on barriers to care for people with SCD revealed that nearly 40 percent of ED providers identified implicit bias as a barrier.123 Evidence
Research has shown that Black patients have lower levels of trust in the health care system due to experiences with biased providers and historical racist practices.124 Distrust in health care is associated with lower rates of recommended disease prevention and treatment of acute and chronic illness, as well as worse health status.125 It is crucial that providers
32 Part I. Recommendations to Improve Both Sickle Cell Disease and Maternal Health Outcomes
