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Students Craft NC Medicaid Reform Proposal

February 28, 2017

The Bass Connections Medicaid Reform Advisory Team combines Duke’s expertise in public policy, law, medicine and business under the umbrella of the Duke-Margolis Center for Health Policy. Team members are crafting 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. Master of Public Policy candidate Madhulika Vulimiri is a team member. Here are her reflections:

As a native North Carolinian and a student of health policy, I’ve been following health reform for a long time. When I saw this Bass Connections project, I was excited for the opportunity to work on Medicaid reform in North Carolina—especially at a time when states have really been at the forefront of innovating in health care—to think about what we could do to further improve the public health of citizens in North Carolina.

This project has allowed me to speak with executives from Duke University Health System, state legislatures and the folks at the Department of Health and Human Services who run Medicaid, hearing their unique viewpoints about how changes to the Medicaid program would affect their organizations. It’s really exciting to take those perspectives and incorporate them into final recommendations.

The most surprising thing I’ve learned is that if you know one state Medicaid program, you know one state Medicaid program. There are certainly lessons to be learned from what other states are doing. However, every state has such a unique history and political environment that we really need to dig into the North Carolina context to understand what hospitals, providers, patients, and government officials want out of a state Medicaid program. We really have our work cut out for us to understand North Carolina’s unique political environment in forming recommendations for the state legislature.

As a student of public policy, it’s my goal to use evidence and research to inform changes to such a massive program like Medicaid that will inevitably affect a number of stakeholders. It’s very important that we are grounding our recommendations in facts about the program, especially at a time when there are a lot of different opinions about how the program has or has not succeeded.

There are a lot of myths swirling around about Medicaid. In particular, you hear people say “Medicaid is broken.” While there are certainly aspects of Medicaid that should be improved, the North Carolina Medicaid Program has a critical way for North Carolinians to get access to life-saving health care and ultimately improve their health outcomes.

If I’ve learned anything, it’s that Medicaid is not one monolithic program. It’s a program that serves a number of diverse beneficiaries, most of them being children. It’s important to remember that with Medicaid, we’re talking about the most vulnerable people in our state, from children to the disabled and the elderly. It’s our responsibility to be the best stewards to those patients and make sure they have access to high quality, affordable health care.

Undergraduate perspective

Undergraduate student Kushal Kadakia is also participating on the team. Kadakia is a sophomore from Houston, Texas. He is studying biology and public policy, with a minor in global health.

I’m interested in health policy because I think it’s a field that allows me to work on one of the nation’s biggest policy problems that has a real human impact. I find health policy personally rewarding because I think it’s a way for me to connect everything I’ve learned in the classroom to a problem that affects every single American. Health care is something that all of us are involved with, whether it’s as a patient, as a provider or as a policy maker.

Talking to legislators from the general assembly, meeting the people who are really leading this reform effort and synthesizing all their viewpoints has put me on the ground, in the middle of the action. I think the most surprising thing about this course is that I’ve learned how many myths there are about Medicaid or health policy in general. Working with my professors and with policymakers to really unpack all the complex details and find out what is the best solution we can provide to patients has been a fascinating experience.

In the future, I hope to have one foot in academia and one foot in the public sphere, using this experience as a platform for how research at the university level can be translated into policy action in the real world to make an impact in my community.

Find out more about the NC Medicaid Reform Team