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The North Carolina Medicaid program currently constitutes 32% of the state budget and provides insurance coverage to 18% of the state’s population. At the same time, 13% of North Carolinians remain uninsured, and even among the insured, significant health disparities persist across income, geography, education, and race.

The Duke University Bass Connections Medicaid Reform project gathered to consider how North Carolina could use its limited Medicaid dollars more effectively to reduce the incidence of poor health, improve access to healthcare, and reduce budgetary pressures on the state’s taxpayers.

This report is submitted to North Carolina’s policymakers and citizens. It assesses the current Medicaid landscape in North Carolina, and it offers recommendations to North Carolina policymakers concerning: (1) the construction of Medicaid Managed Care markets, (2) the potential and dangers of instituting consumer-driven financial incentives in Medicaid benefits, (3) special "hotspotting" strategies to address the needs and escalating costs of Medicaid's high-utilizers and dual-eligibles, (4) the emerging benefits of pursuing telemedicine and associated reforms to reimbursement, regulation, and Graduate Medical Education programs that could fuel telemedicine solutions to improve access and delivery.

The NC Medicaid Reform Advisory Team includes:

Deanna Befus, Duke School of Nursing, PhD ‘17
Madhulika Vulimiri, Duke Sanford School of Public Policy, MPP ‘18
Patrick O’Shea, UNC School of Medicine/Fuqua School of Business, MD/MBA '17
Shanna Rifkin, Duke Law School, JD ‘17
Trey Sinyard, Duke School of Medicine/Fuqua School of Business, MD/MBA '17
Brandon Yan, Duke Public Policy, BA '18
Brooke Bekoff, UNC Political Science, BA '19
Graeme Peterson, Duke Public Policy, BA ‘17
Haley Hedrick, Duke Psychology, BS ‘19
Jackie Lin, Duke Biology, BS '18
Kushal Kadakia, Duke Biology and Public Policy, BS ‘19
Leah Yao, Duke Psychology, BS ‘19
Shivani Shah, Duke Biology and Public Policy, BS ‘18
Sonia Hernandez, Duke Economics, BS '19
Riley Herrmann, Duke Public Policy, BA '17

Library of Congress Subject Headings

Medicaid, North Carolina, Health insurance, Health care reform, Cost of medical care