Medicaid expansion in North Carolina has notably improved payer mix, lowered rates of uninsured and charity care, and boosted billable revenue for safety-net organizations such as Federally Qualified Health Centers. At the same time, expansion has added administrative complexities and enrollment difficulties, which produced uneven benefits across the state's FQHC programs.

In 2021, North Carolina implemented Medicaid transformation, shifting from fee-for-service (FFS) to Managed Care,1 radically changing non-emergency medical transportation (NEMT) services. Research has examined experiences of beneficiaries and providers in navigating this new system, but there has not been a systematic analysis of trends in NEMT usage during the transformation. We analyzed North Carolina NEMT Medicaid claims data between 2019 and 2023. We examined trends in service provision and cost 1) overall, 2) by travel mode, 3) by public versus private provider, and 4) by urban versus rural geography. The database infrastructure used for this project was supported by the Cecil G. Sheps Center for Health Services Research and the CER Strategic Initiative of the University of North Carolina's Clinical and Translational Science Award (5-UL1-TR002489-05). There were increased NEMT claims through both recovery from the COVID-19 pandemic and Medicaid expansion, but these were unevenly distributed across providers and geographies. We found faster growth among private providers, especially those serving Managed Care Organization (MCO) claims rather than fee-for-service claims. We also found disparities between urban versus rural geographies. Our unit of analysis is the Medicaid claim, not NEMT trip or beneficiary. We were limited to broad beneficiary geographic information, which we matched to Department of Health and Human Services (DHHS) county classifications. Medicaid transformation and pandemic recovery occurred simultaneously, complicating separation of their effects. Concentrated growth among urban and private claims highlights difficulty in providing expedient, cost-effective rural NEMT. Increases in cost per claim suggest the new system should be monitored as it pursues its goal of increasing efficiency through transformation.

To the Editor -My father was born in the coal fields of eastern Kentucky.As a child, he watched neighbors' lives cut short by diseases we now know how to prevent.He carried the scars of inadequate dental care for the rest of his life, a reminder of what it meant to grow up poor in rural America.Those experiences shaped his calling to pediatrics and his lifelong advocacy for children who, because of financial, physiological, or behavioral limitations, were too often on the short end of the stick.

By David Huff. This letter of correspondence discusses reclaiming the heart of medicine, offering encouragement to aspiring medical practitioners who wish to connect to the compassionate and patient-centered root of medical practice.

Many barriers exist that impact older adults abilities to access and manage medications. Senior PharmAssist is a nonprofit in Durham that provides medication management and access services to older adults. Here, we describe replication of Senior PharmAssists model in Buncombe, Guilford, and Pitt Counties and highlight learnings from each county.

Pharmacies have long served as trusted health care providers but today face mounting financial pressures from declining reimbursements and rising costs. Pharmacy owners must adapt, balancing patient care with business demands. Sustainable cash flow, strategic planning, and capitalization are essential as closures increase and access to community-based pharmacy care hangs in the balance.

North Carolina pharmacists can initiate certain medications such as hormonal contraceptives, glucagon, and post-exposure prophylaxis for HIV under statewide protocols. Clinical Pharmacist Practitioners provide health care services in collaboration with physicians. New legislation authorizes pharmacists to test for and treat influenza and requires insurers to credential pharmacists as providers.

By Anthony N. Galanos. Anticipatory grief impacts clinicians, their patients, and the patients' families. In times of uncertainty, it is important to hold on to your relationships, especially the relationship with the patient.

In this study, we aimed to examine postpartum health care utilization and identify gaps in care among a postpartum Medicaid population of patients diagnosed with opioid use disorder (OUD) during pregnancy. We queried North Carolina Medicaid medical and pharmacy claims to identify individuals with a live delivery and evidence of OUD during pregnancy from 2015 to 2019. We examined any evidence of postpartum health care utilization and evidence of medications for OUD (MOUD) during postpartum. We also determined the impact that 4 factors may have had on these outcomes: type of Medicaid coverage (Medicaid for Pregnant Women as compared to other types of Medicaid coverage), rurality, race, and the prenatal use of MOUD. Descriptive statistics, Kaplan-Meier curves with log-rank tests, and negative binomial regression were used. Of the 6,186 individuals in the study, 84.5% were White, 29.6% lived in rural areas, and 35.0% had MPW coverage. Of the sample, 77.4% sought health care services during the postpartum period. In the multiple negative binomial regression model, individuals who were MPW beneficiaries, non-White, lived in rural areas, and had no evidence of prenatal MOUD all had significantly lower rates of postpartum health care utilization. Of the sample, 53.6% had evidence of MOUD utilization during the postpartum period. We found that patients with MPW continued MOUD at much lower rates compared to patients with other forms of Medicaid (86% versus 93% at 60 days; 57% versus 78% at 180 days, respectively). Limitations to this analysis are inherent to administrative claims data, such as misclassification of outcomes and covariates, as well as loss to follow-up. Significant gaps in health care use remain across type of Medicaid coverage, race, geographic setting, and prenatal care access.

By Raydiance Swanston. The evolution of the Mecklenburg County Dental Clinic to a value-based, integrated care approach has impacted our patients’ health outcomes and reshaped how we deliver dental care in our community.