Duke-Margolis recommends North Carolina take the most comprehensive approach to integrating Medicare-Medicaid and achieving comprehensive care for the person

Duke-Margolis recommends North Carolina take the most comprehensive approach to integrating Medicare-Medicaid and achieving comprehensive care for the person

DURHAM, North Carolina, October 24, 2022 /PRNewswire/ — New Duke-Margolis recommendations urge the North Carolina Department of Health and Human Services (NC DHHS) to pursue the most comprehensive level of integration of the state’s Medicaid program with Medicare to ensure that the 275,000 eligible North Carolinas have access to “comprehensive care” that will meet their diverse physical, behavioral and social needs. North Carolina is on the cusp of a major transition of its state Medicaid program from fee-for-service (FFS) to managed care and NC DHHS is mandated to transition eligible North Carolina residents, also known as the name of dual-eligible beneficiaries for Medicaid managed care by 2026 .

The Duke-Margolis report, “North Carolina Medicare-Medicaid Integration: Advancing Whole Person Care“, developed with the support of an Arnold Ventures grant, provides the NC DHHS with pragmatic, evidence-based options for integrating Medicare-Medicaid in the state. The report is accompanied by a practical guide for states interested in developing a Medicare-Medicaid Integration Strategy These recommendations build on the 2017 state report and address key policy design and implementation issues, including eligibility , structure, plan design, phasing in of populations and services, and program monitoring.

“We are excited to strengthen our partnership with our academic colleagues across the state to ensure that our approach is an innovative, evidence-based model that makes North Carolina a national leader in delivering high-quality, coordinated and integrated care to Medicaid and Medicare beneficiaries,” said David Richardassistant secretary of North Carolina Medicaid.

The report presents a vision of holistic care for recipients with dual state eligibility that prioritizes their needs and preferences and those of their families, resulting in better health, health equity, and improved outcomes. experiences.

“Too often, in health, we fail to focus on what really matters to people, especially the most vulnerable. , like the recommendations offered by the Duke-Margolis team in this document, will help improve health and health care for this important group through North Carolina,” said dr. Marc McClellandirector of the Duke-Margolis Center for Health Policy.

“Our vision and recommended strategy for the integration of Medicare and Medicaid into North Carolina aligns with the state’s overall transformation efforts and creates pathways for innovative collaborations across the state that can help provide holistic care and better health outcomes for dual-eligibility recipients,” said Aparna HigginsSenior Fellow, Duke-Margolis Center for Health Policy and co-lead of the project.

The report outlines options for increasing levels of Medicare-Medicaid integration for the state and recommends the most integrated approach, as well as key elements needed to support beneficiary-centered and whole-person care:

  • Use of primary and interdisciplinary care teams with models of care tailored to the unique needs of the dual-eligibility beneficiary.
  • Improved protections and services for beneficiaries, such as assistance with complaints and appeals or connection to community resources.
  • Integration of existing state efforts through Medicaid Transformation and Healthy Opportunity pilot programs with supplemental Medicare Advantage benefits to meet the social needs of beneficiaries.
  • Support for robust data and infrastructure capacity, state administration capacity, and broader human resources needed to successfully implement and sustain integration.

The recommendations were informed by a 21-month, multi-component Duke-Margolis project encompassing extensive analysis of combined NC Medicaid and Medicare data and extensive input from NC stakeholders and national Medicare-Medicaid integration experts.

“As North Carolina continues to transform care for Medicaid beneficiaries, our report highlights the unique experiences and challenges faced by eligible dual beneficiaries and how integration with Medicare has the potential to improve care and outcomes for these individuals and their families,” said Dr. Brystana Kaufman, senior faculty member of the Duke-Margolis Center for Health Policy and co-director of the project.

About the Duke-Margolis Center for Health Policy

The mission of the Robert J. Margolis, MD, Center for Health Policy at duke university is to improve health, health equity and the value of health care through practical, innovative and evidence-based policy solutions. For more information, visit healthpolicy.duke.edu and follow us on Twitter @DukeMargolis.

Media contacts:

Patricia GreenDuke-Margolis Center for Health Policy
[email protected]
+1 301 520 6482

SOURCE Duke-Margolis Center for Health Policy

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