5. Administrative Burden
When determining the withhold percent, NC Medicaid has several payment specificities to consider. Some states have robust methods to these calculations with respect to quality measures. For example: • Louisiana withholds one percent of each MCO monthly capitated payment, which can be earned back if the MCO meets the state-established measure or improves two percentage points from the prior year.429 • Missouri and Ohio withhold three percent of each MCO annual capitated payment, which can be earned back if the MCO meets certain standards on HEDIS measures. High-performing MCOs in Ohio are eligible for an annual bonus, which is funded by an unreturned withheld dollars.430 Additional Considerations
NC Medicaid’s plan to consider overall and relative performance improvements in disparate outcomes when it determines rewards for quality metrics is promising. Disaggregating the quality measures (hypertension, tobacco cessation, perinatal depression screening and follow-up, and substance use screening and intervention) specifically for pregnant and postpartum women as separate measures to withhold PHP capitation payments would incentivize PHPs to improve maternal health outcomes but requires a medium-term investment from NC Medicaid. NC Medicaid cannot withhold payments until 2023. Additionally, NC Medicaid would need to analyze the disaggregated data submitted by PHPs in order to confirm that there have been recent and consistent racial and ethnic disparities among these quality metrics.
NC Medicaid should reduce administrative burdens that keep pregnant and postpartum enrollees from enrolling in Medicaid. Implementation: • NC Medicaid should create a shortened Medicaid enrollment form specifically for pregnancy Medicaid. • NC Medicaid should pursue a State Plan Amendment to exempt under 21 pregnant people from income determination for pregnancy Medicaid.
NC Medicaid should improve enrollees access to translation services during perinatal appointments. Implementation: • NC Medicaid should incentivize PHPs to reduce wait times for translation services during perinatal appointments and increase access to translation services through telehealth. North Carolina Context
Much of the administrative side of NC Medicaid happens at county health departments, making for unique management challenges in easing administrative burdens for Medicaid enrollees. North Carolinians may apply to Medicaid by phone, paper application, in-person, or online. A simplified web application is available across the state in English and Spanish through ePass offered by NC Medicaid. Administrative burdens present a barrier for potential enrollees to access benefits and care. Data from NC DHHS suggests that some pregnancy Medicaid enrollees do not enroll until relatively late in their pregnancy. In 2019,
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