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From Heartland Institute Medicaid Report Card Ranks Kansas First

How will the Heartland Institute's Medicaid report card affect the North Carolina Department of Health and Human Services?

North Carolina's Medicaid performance scores critique DHHS program integrity and design The Heartland Institute's new Medicaid report card ranked North Carolina 48th of 50 states, providing a detailed critique of the state's health program administration. The report specifically marked down North Carolina for poor program design and low program integrity, citing a score of 7 out of 36 points for design and placing the state in the bottom fifth of states for fraud convictions. These findings directly evaluate the operational effectiveness of the North Carolina Department of Health and Human Services in managing its Medicaid program.

Reported by 1 independent outlet Written Oct 7
Effect
Strong negative
How direct
2 steps, all reported
When
Within weeks
The story
Gone quiet

How it reaches North Carolina Department of Health and Human Services

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The facts so far

As reported. Each one links to where it comes from.

  • North Carolina ranked 48th of 50 states in the Heartland Institute's Medicaid report card.carolinajournal.com
  • North Carolina scored 28 of 100 points in the report, which was released on September 27.carolinajournal.com
  • The state scored worst on program design, earning 7 of 36 points.carolinajournal.com
  • The state's Medicaid Fraud Control Unit won 0.22 convictions per 100,000 enrollees in 2024, placing it in the bottom fifth of states.carolinajournal.com

Why it matters

The performance of the Medicaid program is critical for North Carolina, as Medicaid covers about 3 million residents, roughly one in four, and consumes nearly a fifth of the state-funded budget. Poor performance in program integrity and design suggests systemic issues in how the Department of Health and Human Services manages eligibility, controls spending, and prevents fraud, which directly impacts the financial stability and public trust in the state's healthcare system.

This critique comes amid ongoing political and financial battles over Medicaid funding in North Carolina. The report highlights that while other states, like Kansas, ranked first, North Carolina struggled with issues such as restricting new hospitals and clinics through certificate-of-need laws, and requiring nurse practitioners to work under physician supervision.

What we don't know yet

  • How will the North Carolina General Assembly respond to the report's specific recommendations regarding program design and fraud control?
  • What operational changes will the Department of Health and Human Services implement to address the low program integrity scores?

What would change this answer

The state legislature passes new funding or regulatory measures in response to the report.The negative effect could be mitigated if the new measures address the specific failures cited, such as fraud conviction rates or program design.
The Department of Health and Human Services fails to address the issues raised by the report.The negative political and operational pressure on the agency will likely increase, potentially leading to further scrutiny.

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Questions worth asking

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  • About U.S. Department of Health and Human Services

    Does the federal government set the standards that the Heartland Institute is using to critique North Carolina's program design?

  • About Mdhhs

    How does the specific structure of the Medical DHHS influence its ability to address the systemic issues highlighted by the report card?

  • About Legislative information

    Given the critique of program design, what specific legislative actions could the North Carolina General Assembly take to address the issues raised?

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The full eventHeartland Institute Medicaid Report Card Ranks Kansas First Everything aboutNorth Carolina Department of Health and Human Services

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