February 22, 2021

The Joint Legislative Committee on Access to Care and Medicaid Expansion convened last Friday for its first meeting. The committee received presentations on a wide range of topics related to improving access to health care and health insurance for North Carolinians. Many of the presentations contained a high-level overview of the issues and the committee plans to dive into greater detail in subsequent meetings. Below is a brief summary of the meeting with links to the presentations that were shared.

  1. The committee first received a presentation on the impact of the federal  government’s “surprise billing” law on states. The presentation described how states would need to implement this law through basic enforcement for consumer protections (policing noncompliance by insurers and providers), implementing dispute resolution rules for insurers and providers, and potentially including omitted services such as laboratory services or ground ambulances. Additional implications for states to consider include network adequacy issues and the implementation of an all-payer claims database.
  2. The National Conference of State Legislators presented on how North Carolina’s health care system compares to other states. The presentation gave an overview of state policies that could increase access to care, including expanding scope of practice, recruitment and retention efforts for health care providers, telehealth policy levers, interstate licensure compacts, supporting rural health care facilities, certificate of need reform, and Medicaid expansion. Many states implemented waivers or enacted executive orders during the pandemic to increase access to health care services and are discussing ways to make some of these flexibilities permanent. The last half of the presentation focused on successful Medicaid expansion models and outcomes in other states.
  3. The NC Rural Health Research Program at the UNC Sheps Center for Health Services Research presented on rural hospital closures in NC and gave an overview of a new Rural Emergency Hospital (REH) model. Since 2005, 11 rural hospitals have closed in NC, causing patients in affected communities to travel between 5 and 30 miles to access inpatient care. Most of the rural hospital closures across the country have occurred in the Southern region and in states that have not expanded Medicaid. Some states are now considering Rural Emergency Hospitals (REH) as a new model of rural healthcare in certain areas. REHs are facilities that provide ED care, observation care, outpatient services and optional SNF care, but do not provide inpatient services.
  4. The Sheps Center also presented on NC Nursecast, a tool from the Sheps Center to customize forecasts by nurse type (RN/LPN) and geography (statewide, Medicaid regions, AHEC regions and metro/non-metro) for various practice settings. Pre-Covid, NC was forecasted to face an estimated shortage of 12,500 RNs by 2033. If burnout or other factors cause nurses to exit the workforce five years earlier, the shortage nearly doubles. Hospitals, nursing homes, and extended care and assisted living facilities face largest RN shortages. The Northwest/Triad and Piedmont/Triangle have the largest projected shortfalls of RNs by 2033. The presenter highlighted the need for NC to create a statewide health workforce planning organization charged with identifying coordinated action to address health workforce shortages.

The committee plans to convene again on March 1st and March 15th to receive an in-depth overview of North Carolina’s Medicaid program.