Commentary

North Carolina’s Medicaid reform is missing one transformative component

Dr. Mandy Cohen, Secretary of North Carolina’s Department of Health and Human Services, hosted the fourth and last Medicaid Reform Public hearing last night in Raleigh. Secretary Cohen noted that even though there were hearings last year before the previous administration submitted its plan to move North Carolina’s Medicaid program to a hybrid managed care model, she wanted to hear from providers, Medicaid enrollees, advocates and community members. And like last year’s hearings, approximately half of the comments highlighted the fact that Medicaid reform is not going far enough because the state has not closed the coverage gap.

Mothers, stroke survivors, pediatricians, representatives of health insurers, and members of the faith community all called for North Carolina to extend Medicaid coverage to 500,000 North Carolinians in the coverage gap. Thirty-two states – including Washington D.C. – have successfully extended coverage to veterans, low-wage workers, students, and parents.

One health concern that was raised many times in relation to closing the coverage gap is addressing North Carolina’s opioid crisis. If lawmakers lift the Medicaid blockade, 20 percent of uninsured adults with opioid addiction can finally access the care they need. On top of that, research shows that there are at least 144,000 uninsured North Carolinians with substance use disorders or mental illness that would benefit in lawmakers extend Medicaid coverage. Research also shows that Medicaid coverage increases one’s ability to access both inpatient and outpatient treatment. For example, 37 percent of people with Medicaid coverage are able to receive treatment for opioid addiction compared to only 20 percent of the uninsured.

One of the most sobering comments came from a representative from Coastal Children’s Services. The Wilmington area is one of the the state’s hardest hit for opioid abuse and this has impacted the care at Coastal Children’s Services as between 15 and 20 percent of babies in the NICU are experiencing opioid withdrawal. Stories like this further reinforce comments along the line of one of the more pointed and succinct ones uttered last evening: “Obviously we need to expand Medicaid. Everyone knows that except for ten people in legislature.”

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