To support the North Carolina Department of Health and Human Services (NCDHHS) goals to achieve health equity, NC Medicaid is introducing an enhanced payment to Carolina Access primary care practices serving beneficiaries from areas of the state with high poverty rates.
This initiative ultimately aims to improve access to primary care and preventive services for Medicaid and NC Health Choice beneficiaries in North Carolina at a time when historically marginalized populations are facing challenges highlighted by the COVID-19 public health emergency. These payments will be available for three months as a limited initiative from April-June 2021.
This bulletin sets forth the criteria and the amount of the enhanced rate, and the intended use of the funds. In addition, we provide some additional resources on health equity and outline a future webinar opportunity.
Eligibility and Payment Amount
To be eligible for these payments, the practice must be Carolina Access I or II. Practices must meet a minimum beneficiary poverty score, determined by the average poverty rate for the census tracks of the beneficiaries assigned to each practice’s location. Enhanced per member per month payment amounts will be as follows:
- $9.00 per member per month enhancement for practice locations identified as Poverty Tier I (poverty scores above 17% through 21%)
- $18.00 per member per month enhancement for practice locations identified as Poverty Tier II (poverty scores above 21%)
Enhanced payments for eligible practices will automatically be added to monthly Carolina Access payments (and Advanced Medical Home glidepath payments for qualifying practices) for April – June 2021. Practices receiving enhanced payments must complete a practice survey following this health equity initiative; failure to complete the survey may result in NC DHHS recouping payments. The survey will be provided by email and will seek to understand how the payments advanced health equity for the practice and will inform future initiatives.
Use of Payments
Practices are directed to use these funds to enhance primary care medical home services to support beneficiaries to ultimately address health equity, such as:
- Making permanent enhancements to telehealth access,
- Engaging patients to close care gaps in key health areas such as prevention and maternal and child health,
- Staff training on implicit bias, trauma informed care and health equity,
- Quality and clinical data analysis and action plans,
- recruitment of key staff to reduce health inequity such as clinical pharmacists, dieticians, community health workers, health coaches, and doulas,
- COVID-19 specific response such as additional vaccine outreach and distribution efforts to historically marginalized populations,
- Improving the practice infrastructure to address non-medical drivers of health, and
- Investing in behavioral health supports and enhancing integration of behavioral and physical health.
Resources are available at the following websites:
- CDC Practitioners Guide for Advancing Health Equity
- AAFP Addressing Social Determinants of Health in Primary Care
- IHI Achieving Health Equity
- NCHA Resource Center
NC Medicaid will be hosting Virtual Office Hours on Thursday March 25, 2021, from 4-5 p.m. Information about registration is available here. Providers are encouraged to submit questions in advance to Medicaid.email@example.com for discussion.
NC Medicaid will evaluate this initiative with a practice survey to understand how the enhanced payments supported the unique needs of beneficiaries living in high poverty areas of the state or who are part of historically marginalized populations. The information gathered from this initiative will assist with more targeted investments in programs that are shown to improve beneficiary access to care in key areas where health disparities and disparities in care exist. The work will inform NC Medicaid’s broader goals of promoting primary care and prevention while reducing the longstanding health disparities that were exacerbated during the COVID-19 pandemic.
NC Medicaid anticipates that payments will be made to eligible practices in April 2021.
NC Medicaid Contact Center, 888-245-0179