Nonprofits at the Table: Medicaid Transformation

As a key stakeholder that educates, connects, and advocates for nonprofits, the North Carolina Center for Nonprofits plans to provide education programs regarding value-based care and its impact on our state’s nonprofits. With the generous support of the Kate B. Reynolds Charitable Trust and Blue Cross and Blue Shield of North Carolina Foundation, the Center is honored to lead this educational effort. 

Project support provided by

Blue Cross Blue Shield and Kate B. Reynolds Foundations


Medicaid – Say What?

Two terms – Medicaid transformation and Medicaid expansion – are being bantered around a lot these days. Though related, they’re different.

  • Medicaid transformation is the ongoing switch to a privatized managed care system from North Carolina’s current fee-for-service model, where the state pays for every doctor visit and hospital stay for the 2.1 million low-income North Carolina seniors, disabled persons, children and their mothers already on the federal safety net program. In the new managed care system, the state will pay preselected managed care companies a per-person rate to handle all of an individual’s health care needs.

  • Medicaid expansion is an outgrowth of the Obama administration’s Affordable Care Act and would use mostly federal dollars to extend Medicaid coverage to low-income adults currently unable to afford to buy their own health insurance on the open marketplace. North Carolina is one of 14 states, mostly in the Southeast, who have not expanded Medicaid.

Source: North Carolina Health News, a sidebar within a 9/4/19 article by Sarah Ovaska-Few


Education Program Highlights

Statewide Survey

The Center conducted a survey of health service organization nonprofits to learn about their practices, experiences, capacities, and knowledge about changes to value-based care. Results will help the Center and its funding partners plan and recommend future professional development opportunities to help nonprofits navigate Medicaid transformation.


Listening and Learning Tour

The Center hosted invitation-only focus groups in November 2019 in Marion, Greensboro, and Greenville to have a conversation about what nonprofits know, don’t know, need and want related to Medicaid transformation. Results will help the Center and its funding partners plan and recommend future professional development opportunities to help nonprofits navigate Medicaid transformation.


Resources

Explore these resources to learn more about Medicaid transformation:

  • DHHS Suspends Implementation of Managed Care.” NC DHHS announced on November 19, 2019 that because the NC General Assembly did not take needed action, managed care implementation and open enrollment for NC Medicaid must be suspended.
  • Medicaid Transformation, NC Department of Health and Human Services (NC DHHS).  Overview about transition to Medicaid managed care in 2020 – the most significant change to the NC Medicaid program in over 40 years.
  • “Provider Transition to Medicaid Managed Care 101,” NC DHHS, March 2019.  Overview of Medicaid transformation vision, and context, plus managed care definitions and system descriptions.   
  •  Healthy Opportunities. Description of NC DHHS’s initiative.  Includes links to information about Healthy Opportunity Pilots, NCCARES360, policy papers, and NC maps showing social determinants of health indicators. 
  • “Healthy Opportunity Pilots” (slide deck), presented by Elizabeth Cuervo Tilson, MD, MPH, State Health Director/Chief Medical Officer, NC DHHS, September 2019.