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Duke/UNC Student Medicaid Reform Plan

Duke/UNC Student Medicaid Reform Plan

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Published by adamsearing
Plan to reform NC's Medicaid program developed by Duke/UNC public policy students.
Plan to reform NC's Medicaid program developed by Duke/UNC public policy students.

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Published by: adamsearing on Feb 28, 2014
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03/04/2014

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 A New Health Reform Framework For North Carolina
MEDICAID REFORM IN NORTH CAROLINA
February 27, 2014
Duke-UNC Student Medicaid Reform Team
 
DISCLAIMER
This student paper was prepared in Fall 2013 in partial completion of the requirements for Duke-UNC Student Medicaid Reform Team, a course in the Master of Public Policy Program at the Sanford School of Public Policy at Duke University. The research, analysis, policy alternatives, and recommendations contained in this paper are the work of the student team that authored the document, and do not represent views of the Sanford School of Public Policy, Duke University, or the University of North Carolina at Chapel Hill. This report is being circulated for discussion and comment purposes only. It has not been subject to any official review by the faculty or administration of the Sanford School of Public Policy, Duke University, or the University of North Carolina at Chapel Hill.
 
 
 
Student White Paper
!
 
A New Health Reform Framework For North Carolina
 
2
TABLE OF CONTENTS
EXECUTIVE SUMMARY 4
 
Background 4
 
Recommendations 5
 
Analysis 5
 
I.
 
INTRODUCTION 7
 
Current State of North Carolina 7
 
ACA Impact 8
 
Not Expanding Medicaid Leaves Coverage and Financing Gaps 9
 
II.
 
MECHANICS OF EXPANSION 11
 
Traditional Medicaid 12
 
Private Option 12
 
Federal Requirements for Enrolling Medicaid-Eligible Individuals in Marketplace Plans 13
 
SUMMARY 15
 
III.
 
OPERATIONS OF EXPANSION 16
 
Eligibility determination 16
 
Enrollment system 16
 
IV.
 
OVERVIEW OF COSTS 18
 
Estimates of Costs 18
 
Instructions/Caveats for Use of Estimates 18 Discussion of Caveats and Assumptions 19
 
Health Status of Newly Eligible 19
 
Total Enrollment of Newly Eligible Individuals 19
 
Woodwork Effect 19
 
Crowd-Out Effect 20
 
Administrative Costs 20
 
Cost Growth Methodology 22
 
V.
 
IMPACT ON THE HEALTH CARE SYSTEM 24
 
Overview 24
 
Impact on Hospitals 25
 
Current State of North Carolina’s Hospitals 25
 
Impact of the Plan on North Carolina’s Hospitals 26
 
Recommendations for the State and for Hospitals 26
 
 
 
Student White Paper
!
 
A New Health Reform Framework For North Carolina
 
3
Impact on Primary Care and Rural Health Providers 27
 
Current State of the Primary Care Workforce and Rural Health Needs 27
 
Impact of Medicaid Expansion on Existing Primary Care and Rural Health Providers 28
 
Impact of Medicaid Expansion on Provider Supply 29
 
Impact on Federally Qualified Health Centers 30
 
Recommendations for Providers, FQHCs 31
 
Impact on Behavioral Health 31
 
Current State of the Behavioral Health Workforce and Behavioral Health Needs 31
 
Impact on the Behavioral Health Workforce and Need in Community 32
 
Recommendations for Behavioral Health 33
 
Impact on Community Care of North Carolina 33
 
Current State of Community Care of North Carolina 33
 
Recommendations for CCNC 34
 
VI.
 
CONCLUSION 36
 
APPENDICES 37
 
Appendix A.
 
North Carolina Medicaid Reform Advisory Group 37
 
Appendix B.
 
North Carolina’s Next Steps 38
 
Appendix C.
 
10 Essential Health Benefits 39
 
Appendix D.
 
Required components of enrollment system 40
 
Appendix E.
 
Additional Information on Cost Estimates 41
 
General Methodology 41
 
Results Compared 44
 
Upper and Lower Bound Estimates 46
 
Appendix F.
 
A Contrast – Modeling the Macroeconomic Impact of “Medicaid Expansion” in North Carolina 48
 
Appendix G.
 
Additional information on hospitals 49
 
Appendix H.
 
Additional Information on CCNC 53
 
Appendix I.
 
Medicaid Myths 54
 
Myth 1: Medicaid is an inefficient program 54
 
Myth 2: Patients in Medicaid have worse health outcomes than the uninsured. 56
 
REFERENCES 58
 

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