North Dakota’s legislature meets every two years in Bismarck. During the 2023 legislative session, CHAD is working to promote policy priorities for community health centers and their patients. Those priorities included support Medicaid payment reform, state investment of CHCs, and expanding dental benefits, community health workers, and childcare investment.
Medicaid Payment Reform
North Dakota Medicaid and community health centers (CHCs) have a shared goal of improving health outcomes for Medicaid beneficiaries. We need a payment model that supports an approach to care proven to improve quality and lower total costs. CHCs are encouraging lawmakers to develop a Medicaid payment model that:
- Supports the types of high-value services that have been shown to improve outcomes, including care coordination, health promotion, help with transitions of care, and assessment of social risk factors to make high-impact referrals to needed community-based services;
- Incorporates evidence-based quality measures and provides financial incentives for providers when quality and utilization goals are met;
- Aligns with existing payment reform models such as patient-centered medical home (PCMH) and Blue Cross Blue Shield of North Dakota’s BlueAlliance program; and,
- Eliminates the counterproductive aspect of the primary care case management program that leads to Medicaid denying needed (and high-value) primary care services. Medicaid’s current refusal to pay for primary care services when the patient sees a provider that Medicaid has not designated as their primary care provider (PCP) leads to unnecessary emergency room visits and large financial losses for CHCs and others trying to serve patients in the community.
Community health centers provide comprehensive care for patients across North Dakota, including dental care. Evidence connects healthy mouths with a healthy body. For example, a 2017 study of people with diabetes shows that medical costs are $1,799 lower for patients who have received appropriate oral health care than those who have not. Insufficient dental coverage can result in additional emergency room visits, which can adversely affect blood pressure, diabetes management, and respiratory health.
- Extend dental benefits to ALL North Dakota Medicaid recipients, including individuals covered by Medicaid expansion.
State Investment in Community Health Centers
Community health centers (CHCs) in North Dakota play an integral role in our state’s health care system serving over 36,000 patients a year. Twenty-nine states currently appropriate state resources to CHCs to support their mission of providing care for underserved and vulnerable populations. North Dakota CHCs would like to be added to this list.
We ask you to consider allocating $2 million in state resources to CHCs to sustain and grow their ability to serve vulnerable and underserved populations in the state. They would use the resources to meet the following goals:
- Reduce emergency room visits and hospitalizations for Medicaid beneficiaries and the uninsured;
- Sustain a needed community resource for the most vulnerable;
- Respond to workforce challenges and shortages;
- Make health IT investments that support quality improvement; and,
- Overcome barriers to health in underserved communities to support access to healthy food and affordable housing, sustain outreach, translation, transportation, and other non-billable services.
Community Health Workers
Community health workers (CHWs) are trained front-line health care workers with social and relational ties to the communities they serve, who work as community-based extensions of health care services. CHWs could expand access to health care in North Dakota, reduce health care costs, and improve health outcomes for North Dakotas. When integrated with primary health care, CHWs can enhance team-based, patient-centered care by complementing the work of health care professionals. CHWs help primary care providers understand the real problems that clients face daily. They can help build trust between patients and their health care teams to solve problems and figure out how to implement their clinical care plans.
As health systems work on strategies to improve health outcomes, reduce health care costs, and reduce health inequities, North Dakota can consider implementing laws to establish sustainable CHW programs.
- Create a supportive infrastructure for CHW programs, addressing professional identity, education and training, regulation, and medical assistance reimbursement.
Invest In Childcare to Provide Accessible, High-Quality, and Affordable Care
Childcare is, of course, a critical component of a thriving economy. Access to affordable childcare is essential for parents to stay in the workforce and an important element of recruiting workers to our communities. On average, working families in North Dakota spend 13% of their family budget on infant childcare. At the same time, childcare businesses struggle to stay open, and childcare workers earn $24,150 if working full-time, barely hovering above the poverty level for a family of three.
- Support increased pay for childcare workers, adjust income guidelines to provide more families with childcare assistance, extend childcare stabilization grants, and expand Head Start and Early Head Start programs.