Duke-Margolis Recommends North Carolina Pursue Most Comprehensive Approach to Integrate Medicare-Medicaid and Achieve Whole-Person Care

DURHAM, N.C., Oct. 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 the 275,000 eligible North Carolinians have access to the "whole-person care" that will address the diversity of their physical, behavioral and social care 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 NC residents, also known as dual-eligible beneficiaries, into Medicaid managed care by 2026. 

The Duke-Margolis report, "North Carolina Medicare-Medicaid Integration: Advancing Whole-Person Care," developed with support from a grant by Arnold Ventures, provides NC DHHS with pragmatic, evidence-based options for Medicare-Medicaid integration in the state. The report is accompanied by a practical guide for states interested in developing a tailored, evidence-based Medicare-Medicaid integration strategy. These recommendations build on the state's 2017 report, and address key policy design and implementation questions, including eligibility, structure, plan design, phase-in of populations and services, and program oversight.

"We are excited to strengthen our partnership with our academic colleagues in the state to ensure that our approach is an innovative and evidence-based model that makes North Carolina a national leader in providing high quality, coordinated, and integrated care for Medicaid and Medicare beneficiaries," said Dave Richard, Deputy Secretary for North Carolina Medicaid.

The report lays out a whole-person care vision for the state's dual-eligible beneficiaries that prioritizes their needs and preferences and those of their families, resulting in better health, health equity, and improved experiences.

"Too often in health care we do not focus on what really matters to people, especially the most vulnerable. Developing new person-centered approaches to delivering and financing care for dual-eligible beneficiaries, like the recommendations offered by the Duke-Margolis team in this paper, will help improve health and health care for this important group across North Carolina," said Dr. Mark McClellan, Director of the Duke-Margolis Center for Health Policy.

"Our vision and recommended strategy for Medicare and Medicaid integration in North Carolina aligns with the state's overall transformation efforts and creates pathways for innovative collaborations in the state that can help deliver whole-person care and better health outcomes for dual-eligible beneficiaries," said Aparna Higgins, Senior Fellow, Duke-Margolis Center for Health Policy and project co-lead.

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

• Use of primary care and interdisciplinary care teams with models of care tailored to the unique needs of the dual-eligible beneficiary.
• Enhanced beneficiary protections and services, such as assistance with complaints and appeals or making connections to community-based resources.
• Integration of existing state efforts through Medicaid transformation and the Healthy Opportunities Pilots with Medicare Advantage supplemental benefits to address beneficiary social needs.
• Support for the robust data and infrastructure capability, state administration capacity, and broader workforce resources needed to successfully implement and sustain integration.

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

"As North Carolina continues care transformation for Medicaid beneficiaries, our report brings into focus the unique experiences and challenges faced by dual eligible beneficiaries and how integration with Medicare plans has the potential to improve care and outcomes for these individuals and their families," said Dr. Brystana Kaufman, Duke-Margolis Center for Health Policy Core Faculty Member and project co-lead.

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 Green, Duke-Margolis Center for Health Policy
[email protected]
+1 301 520 6482

SOURCE Duke-Margolis Center for Health Policy