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NC Medicaid Reform Advisory Team (2016-2017)


August 30, 2016 - May 15, 2017

Project Objectives

What is the best path forward for Medicaid in North Carolina?

Medicaid covers 1.9 million people in North Carolina, mostly low-income children and their parents, the elderly and the disabled. The program costs the state about $14 billion a year, with the federal government covering about two-thirds of the expense.

The Affordable Care Act (a.k.a. %u201CObamacare%u201D) offers states additional federal dollars if states agree to expand their Medicaid programs to all nonelderly adults with income below 133% of the federal poverty level.
North Carolina (along with 18 other states) has opted against Medicaid expansion. Advocates for expansion argue that an additional 300,000—500,000 low-income N.C. adults would gain access to health insurance, with the federal government picking up most of the tab for three years. Opponents cite the growing state financial obligations after those three years, plus the burden of federal mandates that must be followed when accepting federal Medicaid expansion funds.

As the North Carolina General Assembly convenes in January 2017, there will be renewed debates about reform of North Carolina's Medicaid program. This debate will take place in the context of demographic and cost trends that continue to increase beyond the bounds of sustainability.
The question of how our society can provide quality health care at a sustainable cost is one of the most important policy issues of the 21st century and touches all Americans across the education, income, and demographic spectrum.

Duke University is positioned to influence policy by answering pressing questions, such as:
• Will moving from a fee-for-service payment structure to managed care in which commercial organizations and regional provider-led entities would compete to deliver care for patients within a defined budget provide better budget predictability? Better health care?
• Would such a change make providers more likely to accept patients with Medicaid coverage and provide better access to care and better patient outcomes?
• Could a proposed plan for Medicaid reform be adjusted in negotiations with federal regulators to incorporate Medicaid expansion?
The Bass Connections Medicaid Reform Advisory Team will combine Duke's expertise in public policy, law, medicine and business under the umbrella of the Duke-Margolis Center for Health Policy to craft a Medicaid reform proposal designed to fit the constraints and demands of North Carolina politics, especially in light of the revised political landscape resulting from the 2016 elections.

In conjunction with top policy experts affiliated with Duke-Margolis, team members will investigate:
• the political and legal procedures involved in Medicaid reform;
• potential health coverage models and business opportunities to meet the needs of North Carolina's Medicaid beneficiaries;
• the views of a broad range of stakeholders through partnerships with advocacy organizations (such as the N.C. Justice Center, National Health Law Program, Cone Health Foundation and N.C. Community Health Center Association), the Duke Office of Government Relations, health care providers (at Duke, Community Care of North Carolina and elsewhere) and community health institutions (e.g., Lincoln Community Health Center);
• the views of state Republican legislators, including chairs of the relevant committees and their staff, to determine the political landscape after the November 2016 elections.
A team contract and project syllabus will define expectations and goals for the individual participants and the project as a whole. The team will meet on a monthly basis, with sub-teams devising independent meeting schedules to match the ebb and flow of their assigned tasks. A project manager will help to oversee timelines and logistics, as well as keep team members engaged and on task. Grading will be based on measures such as team meeting attendance, participation in meeting

Project Opportunities

The project team will give undergraduate, graduate and professional students the opportunity to work closely with some of Duke’s top faculty, research associates from the Duke-Margolis Center for Health Policy, post-doctoral scholars, and medical resident physicians.

Participants will become well-versed in using research to influence policy-making and, in the process, will gain firsthand experience with government bodies and institutional partners deeply involved in this issue.
Through the generation of this interdisciplinary policy proposal, they will gain experience in balancing the interests and concerns of multiple stakeholder groups to achieve sound policy solutions resulting in the greatest benefit to the greatest number of people.

The proposed work product will be circulated among relevant N.C. legislative members in the spring of 2017, perhaps having a direct impact in policy decision-making on the matter. To maximize this impact, team members will meet personally with members of the N.C. executive and legislative branches, as well as special interest groups and officials at the Centers for Medicare and Medicaid Services.

Team members will be selected based on their ability to demonstrate an understanding of the issues integral to the Medicaid expansion debate and a desire to apply the skills gained from this learning experience in their own work going forward.

We are accepting applications until September 16 and will notify selected students by October Questions regarding the project or the application process can be directed to lysa.mackeen@duke.edu.


Fall 2016 — Spring 2017
In Fall 2016, team members will be provided with a policy reading list and take part in a two-day Medicaid boot camp. Team-building exercises will familiarize participants with each other’s strengths and promote successful collaboration. By January 2017, the team will complete a literature review regarding Medicaid program and policy and a survey of the post-election political landscape. By March 2017, the team will have a draft of the N.C. Medicaid policy proposal, and by April 2017 will have had conversations with policymakers and interest groups about the proposal. In May 2017 there will be a half-day Medicaid conference at Duke to unveil and discuss the proposal.


Independent study credit available for the spring semester

Project Application Process

All interested students should complete the Bass Connections central application process located at www.bassconnections.duke.edu and indicate their selection of this team for the global health option. Final team selection will be completed by October 7 . Questions regarding the project or the application process can be directed to lysa.mackeen@duke.edu.

Project Application Deadline


Project Status



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