NC Medicaid Reform Advisory Team (2016-2017)


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. “Obamacare”) 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?

Project Description

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 meetings, peer feedback and ratings, individual work and group work as well as individual contribution to the final proposal.

Team members will make field trips to Raleigh to witness policy-making in action and present project findings to stakeholders and decision-makers, and will have the opportunity to participate in a Medicaid conference at Duke in May 2017.

Deliverables include sub-team assigned tasks (e.g., literature reviews, policy briefs), final policy proposal and presentation(s) to stakeholders.

Anticipated Outcomes

Deliverables include sub-team assigned tasks (e.g., literature reviews, policy briefs), final policy proposal and presentation(s) to stakeholders.


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.

Team Outcomes to Date

North Carolina Medicaid Reform Advisory Team (Brandon Yan, Brooke Bekoff, Graeme Peterson, Haley Hedrick, Jackie Lin, Kushal Kadakia, Leah Yao, Riley Herrmann, Shivani Shah, Sonia Hernandez, Deanna Befus, Madhulika Vulimiri, Patrick O’Shea, Shanna Rifkin, Trey Sinyard)

North Carolina Medicaid Reform: A Bipartisan Path Forward (April 25, 2017)


Bass Connections: NC Medicaid Reform Team


Kushal Kadakia ’19

Trey Sinyard, MD-MBA Student

Madhulika Vulimiri, MPP Student

This Team in the News

Student Laurels and Honors for 2017

Students Present Their Research and Learn from Each Other at the Bass Connections Showcase

Bass Connections NC Medicaid Reform Team Presents in Raleigh

Student Research Shared, Awards Announced at Bass Connections Showcase

Twelve Students Receive Grants to Take Their Bass Connections Research Further

Reflections on Mentoring from Bass Connections Graduate Students

Students Craft NC Medicaid Reform Proposal

Duke-Margolis Center for Health Policy Director Explains Mission of Center, Future of Health Care Policy

NC Medicaid Reform Advisory Team Kickoff

Trump Administration Brings Opportunities, Risks for NC Medicaid Program

Faculty/Staff Team Members

Hilary Campbell, Duke - Margolis Center for Health Policy
Amanda McMillan, School of Medicine - Duke Clinical & Translational Science Institute
Andrew Olson, DCRI
Allison Rice, Law School Clinics
Elizabeth Richardson, Duke - Margolis Center for Health Policy
Barak Richman, Law School, Fuqua School of Business*
Leigh Ann Simmons, School of Nursing
Donald Taylor, Sanford School of Public Policy*

Graduate Team Members

Deanna Befus, Nursing - PhD
Patrick O'Shea, Fuqua - MBA
Shanna Rifkin, Law
Trey Sinyard, Fuqua - MBA; Medicine - MD
Madhulika Vulimiri, Sanford - Master of Public Policy

Undergraduate Team Members

Sonia Hernandez, Political Science (AB)
Riley Herrmann, Public Policy Studies (AB)
Kushal Kadakia, Biology (BS), Public Policy Studies (AB2)
Jackie Lin, Biology (BS)
Graeme Peterson, Public Policy Studies (AB)
Shivani Shah, Biology (BS), Public Policy Studies (AB2)
Brandon Yan, Public Policy Studies (AB)
Leah Yao

Community Team Members

Brooke Bekoff, UNC Chapel Hill

* denotes team leader