Researchers at UNC-Chapel Hill say more North Carolina Medicaid beneficiaries are avoiding unnecessary hospital visits since the program went through an overhaul.
The university's Cecil G. Sheps Center for Health Services Research released data Friday that show the rate of Medicaid hospital visits has been cut in about half since the COVID-19 pandemic.
The program then transitioned from a fee-for-service model to a managed care system in 2021, a change designed to cut costs and increase access to health care. State lawmakers approved Medicaid expansion under the Affordable Care Act in 2023.
UNC researchers say the rate of preventable hospital visits has declined among Medicaid enrollees by nearly 100 visits per week. The Sheps center says the average cost of a hospital visit in 2021 was $4,915.
Meanwhile, the state Department of Health and Human Services says it's seeing better outcomes since Medicaid expanded.
"The impact of expansion is things like a reduction in opioid use disorder overdoses. This past year, we saw a 27% decrease," said Jay Ludlam, Deputy Secretary of North Carolina Medicaid.
The state health department is also trying to expand its Healthy Opportunities Pilot program, which is meant to address underlying conditions of poor health outcomes like housing insecurity.
"It lowers total adverse acuities in those communities that Healthy Opportunities participates," Ludlam said of the program's first year.
The U.S. House passed a budget last week that would cut $700 billion from Medicaid nationwide over the next 10 years. It has not yet passed the Senate and it's not yet clear how it would affect North Carolina's program.
"If there's pressure on the state system, some of the services the people rely on can go away," said state Representative Sarah Crawford, a Democrat from Wake County, who is also the CEO of Tammy Lynn Center for Developmental Disabilities.
"People will lose jobs. People will not get the health care that they need. And there will be deaths because of this," Crawford said of the budget bill.
"I tell folks, 'Give me a scaffold, not an ax,'" said state Senator Jim Burgin, a Republican from Harnett County, who is also co-chair of the Senate Health Committee.
"There are things that we can do [to make cuts], but we need time to figure out the best way to do this."
Finally, with more than 656,000 North Carolinians being enrolled in the state's Medicaid program since its 2023 expansion, hospitals are being reimbursed for visits from those beneficiaries who would have previously been uninsured.
The Sheps Center's data also show hospitals had significant increases in Medicaid revenue, with rural hospitals getting up to 9% more than urban hospitals six months after expansion.
