Executive Summary
The following report outlines strategies for the North Carolina Department of Health and Human Services (NC DHHS) to consider implementing in order to improve Medicaid enrollees’ access to and quality of care. These strategies specifically focus on the health outcomes and racial and ethnic disparities that exist among two populations, enrollees living with sickle cell disease (SCD) and enrollees who are pregnant or postpartum. This report is based on stakeholder interviews conducted in North Carolina in Fall 2021 and a literature review focused on Medicaid’s role in advancing health equity for these two populations. The interviews and literature review revealed that Medicaid enrollees, including enrollees with SCD and who are pregnant or postpartum, face similar barriers to quality care, such as transportation, provider bias, care management, and data gaps. Several SCD-specific challenges were identified, including continuity of care during the pediatric to adult transition, access to care, and lack of universal screenings. Challenges specifically related to pregnant and postpartum enrollees were also identified, including the lack of clinical and non-clinical support during pregnancy and postpartum and the lack of continuity of care across the peripartum period. This report provides recommendations for NC DHHS to address each of these challenges. The goal of these recommendations is to ensure that the promise of Medicaid Managed Care is fulfilled, and that the needs of enrollees who are at a higher risk of experiencing barriers to quality care are sufficiently addressed. Below is a high-level summary of recommendations for NC DHHS, Medicaid, and/or DPH to implement in order to improve Medicaid enrollees’ access to and quality of care.
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