In July 2021, North Carolina Medicaid and the state’s Children’s Health Insurance Program (CHIP) transitioned from a fee-for-service system to risk-based managed care for most beneficiaries, including most parents, children, and pregnant women. Given the large role Medicaid plays in children’s health and well-being, it is important to document how this transition may affect children's health in North Carolina.

In this chartbook, we use data from the 2016–19 National Survey of Children’s Health to establish baseline estimates of the health status, access to care, service use, and other key indicators of health and well-being for children in North Carolina before the transition to Medicaid managed care and the implementation of other Medicaid transformation initiatives.

Why This Matters

As North Carolina transitions from fee-for-service to managed care for most Medicaid and CHIP enrollees, it is important to establish a baseline for future research assessing the impact of the transition to managed care on children’s health in the state.

What We Found

Children enrolled in North Carolina Medicaid/CHIP before the transition were overall very healthy and had high-quality access to care, sometimes better than children enrolled in Medicaid/CHIP nationally:

• Only 2.5 percent of children enrolled in NC Medicaid/CHIP reported an unmet need for medical care, compared with 4 percent of children enrolled in Medicaid/CHIP nationally.
• Only 1.4 percent of children enrolled in NC Medicaid/CHIP were in fair or poor health, compared with 2.8 percent of children enrolled in Medicaid/CHIP nationally.
• More than 75 percent of children enrolled in NC Medicaid/CHIP had at least one or more preventive medical care visits in the past 12 months, similar to levels of access nationally.
• Only 4 percent of children enrolled in NC Medicaid/CHIP reported a gap in health insurance coverage in the last 12 months, similar to the national average.

However, a few findings signal there are opportunities to further expand access within North Carolina Medicaid/CHIP:

• One in five children enrolled (20.4 percent) did not have any medical visits at all in the past 12 months.
• More than one in six children (17.7 percent) had parents report they felt frustrated when trying to get care for their child in the past 12 months.
• One in four children (25.8 percent) reported their insurance did not cover needed services, and one in five children reported their insurance did not cover needed providers (20.1 percent).

How We Did It

This analysis uses 2016–19 pooled data from the National Survey of Children’s Health to present baseline estimates of demographic and socioeconomic characteristics, patterns of Medicaid coverage, access to care, service use, costs of care, and the social needs of children enrolled in North Carolina Medicaid. We compare estimates for children enrolled in Medicaid in North Carolina to children enrolled in Medicaid nationally using two-tailed t-tests. Differences reported in the text are significant at the p < 0.05 level.