Abstract
Introduction
On July 1, 2021, North Carolina’s Medicaid Transformation mandatorily switched 1.6 million Medicaid beneficiaries from fee-for-service to managed care plans. We examined the early enrollee experience in terms of engagement in plan selection, provider continuity, use of primary care visits, and assistance with social needs.
Methods
Using electronic health records (EHR) covering pre- and post-transition periods (1/1/2019–5/31/2022) from the largest provider network in western North Carolina, we identified all children and adults under age 65 with continuous Medicaid or private coverage. We conducted primary surveys of a random sample of Medicaid-covered enrollees and obtained self-reported rates of engagement in plan selection, continuity of provider access, and receipt of social need assistance. We used comparative interrupted time series models to estimate the relative change in primary care visits associated with the transition.
Results
Our EHR-based study cohorts included 4859 Medicaid and 5137 privately insured enrollees, with 398 Medicaid enrollees in the primary surveys. We found that 77.3% of survey participants reported that the managed care plan they were on was not chosen but automatically assigned to them, 13.1% reported insufficient information about the transition, and 19.2% reported lacking assistance with plan choice. We found that 5.9% were assigned to a different primary care provider. Over 29% reported not receiving any additional social need assistance. The transition was associated with a 7.1% reduction (95% CI, –11.5 to –2.7%) in the volume of primary care visits among Medicaid enrollees relative to privately insured enrollees.
Conclusions
Medicaid enrollees in North Carolina may have had limited awareness and engagement in the transition process and experienced a reduction in primary care visits. As the state’s transition process gains a foothold, future policy needs to improve enrollee engagement and develop evidence on healthcare utilization and patient outcomes.
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Data Availability
The data are not publicly available due to patient’s privacy and consent. The deidentified data that support the findings of this study may be available upon reasonable request to the corresponding author.
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Funding
This research has been supported by a grant from the Kate B. Reynolds Charitable Trust. The Trust had no participation in the “design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and the decision to submit the manuscript for publication.” Deepak Palakshappa is supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health under Award Number K23HL14690. Rachel Zimmer is supported by the Department of Health and Human Services Geriatric Academic Care Award Number K01HP33462. Amresh Hanchate and Lindsey Abdelfattah had full access to the data used for the study and take responsibility for the integrity of the data and the accuracy of the data analysis. The views expressed in this article are those of the authors and do not necessarily represent the views of the Kate B. Reynolds Charitable Trust and Wake Forest University School of Medicine.
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Hanchate, A.D., Abdelfattah, L., Palakshappa, D. et al. North Carolina’s Medicaid Transformation: the Early Enrollee Experience. J GEN INTERN MED 38, 3295–3302 (2023). https://doi.org/10.1007/s11606-023-08319-9
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DOI: https://doi.org/10.1007/s11606-023-08319-9