While fighting to move beyond the coronavirus pandemic, North Carolina’s public health team has been transforming the Medicaid system, too.
By Anne Blythe
North Carolinians who have received a COVID-19 vaccine and are 18 and older could be one of four people this summer to win $1 million.
Gov. Roy Cooper announced on Thursday that he was taking a page from Ohio Gov. Mike DeWine’s pandemic playbook, and from other states, too, for a different way to use federal funds to fight COVID-19.
The plan in NC: Creating a lottery incentive program to push up vaccination rates.
“We’re pulling out all the stops,” Cooper said during a briefing with reporters. “After studying how similar efforts have boosted vaccine rates in other states, today we are announcing that North Carolina will launch cash drawings for our residents who have gotten a vaccine.”
Through the program, “Your Shot at a Million: Summer Cash Drawings,” all adult North Carolinians who have been vaccinated will automatically be entered into four drawings for a chance to win $1 million cash prizes.
All North Carolina residents who are 12 through 17 and have received at least one vaccine dose will be entered into four drawings in which they could win $125,000 for college or other post-secondary education at a school of their choice.
“Regardless of who wins, there is no way to lose. A chance at a million dollars or a college scholarship is pretty good motivation,” Cooper said. “But even if your name isn’t drawn, the worst you’ll do is get strong protection from a deadly virus.”
DeWine, Ohio’s governor, grabbed big headlines on May 12, when he announced that his state would use federal coronavirus relief funds to establish a Vax-A-Million lottery.
In an opinion piece written by DeWine and published May 26 in The New York Times, the governor said the results of his experiment exceeded his “wildest expectations.”
By mid-April, he was seeing demand for the vaccine dip below the supply numbers. After his announcement, according to his analysis, vaccinations for adults were up 49 percent.
The demand for vaccinations in North Carolina hit its peak on April 5, according to the DHHS vaccine dashboard, and almost immediately began to decline. The rate of people rolling up their sleeves hit a lull in May.
The state’s public health team stopped planning large vaccine events that had drawn long lines earlier this year and shifted to more targeted clinics in communities, churches and other smaller gathering places.
At the end of May and into June, the state Department of Health and Human Services, started offering incentives such as $25 Summer Cash Cards to people who got vaccinated or drove someone to get vaccinated at specific sites in Guilford, Mecklenburg, Rockingham and Rowan counties.
Some 2.5 million adults in North Carolina still have not gotten vaccinated.
“There are many reasons why 45 percent of adults in North Carolina have not taken their shot,” Mandy Cohen, the DHHS secretary, told reporters on Thursday. “Some people may need help covering the cost of taking time away from work or transportation costs.”
$25 Summer Cash cards
Cohen and Cooper said Thursday that they are considering expanding the cash program to other counties, too, even with the lottery up and running.
In addition to trying to remove the cost barrier that has kept some from getting vaccinated, Cooper and Cohen know some people still have questions about the safety and effectiveness of the vaccines and feel more comfortable sorting through that with their doctor or family members.
“Already, we’re seeing these vaccines are helping us do the things we love to do safely,” Cooper said. “Gathering with friends and family, eating indoors at a restaurant, going to a game, hugging a grandchild. All of that is a testament to just how safe and effective these vaccines are, and the more North Carolinians who get vaccinated, the sooner we can put this pandemic fully behind us.”
Lagging, not bragging in NC
The stated goal in North Carolina has been to get at least 66 percent, or two-thirds, of the population vaccinated, far above the 40 percent of the total population currently vaccinated.
“We want to go beyond that,” Cohen said of the stated goal. “We just want to make sure that folks know there are incentives out there, that vaccinations are safe and effective. We want to answer people’s questions, make it convenient for them. That’s what we’re focused on.”
In New England, the vaccination rates are higher than in other regions of the country. By late May, more than 70 percent of the adult population in every New England state had received at least one COVID vaccine dose. In North Carolina, only 54 percent of adults have gotten at least one vaccine dose.
“If you look at North Carolina compared to some other states, we are starting to lag behind,” Cohen said. “I’m proud that we are doing well compared to a lot of other states in the South, but there are many states who are now seeing 70 percent of their adults vaccinated. We can get there, too. I hope today’s announcement will help us launch forward even faster.”
Anyone who gets vaccinated after Thursday will be entered twice into the lottery drawings, which will be held every other week beginning June 23.
“A lot of people are not opposed to getting a shot but simply have a busy life, don’t realize it’s important to themselves and their families, and we are seeing in other states, the things that have motivated people to say, ‘Okay, I was going to do that anyway. Hey, maybe I can win a million dollars or maybe I’ll get this $25 cash card,” Cooper said. “Whatever motivates people, we want to do what works because it’s not only important for that person and their family, but it’s important for our entire state.”
The numbers of people hospitalized and in intensive care units battling severe illness related to COVID-19 has continued to drop since vaccines became available in late December.
Daily case counts have dropped significantly, too.
“It’s because of the vaccine,” Cooper said. “But every day, we have people still going into the hospital. Every day, we have people going into the ICU. Most every day people are still dying from COVID. So it’s still here.”
Transforming Medicaid in a pandemic
As Cooper and Cohen try to move North Carolina beyond the COVID-19 pandemic, the public health team is working on another major shift.
North Carolina is in the process of transforming the Medicaid system from a fee-for-service program to a managed care system in which Medicaid recipients will be matched with insurance providers.
“This is a significant change in the administration of Medicaid that the legislature put in place several years ago,” Cooper said. “Dr. Cohen and her team have been working constantly on this to make this change as smooth as possible for both the Medicaid recipients and the health care providers.”
While the changeover is likely to create many questions from recipients, Cooper said Thursday that his administration was looking for “positives” to tout such as the Healthy Opportunities Program.
Through that program, Cooper said, some Medicaid funds could be used to prevent illnesses and chronic problems. For example, for a person with asthma, the solution might be to replace the moldy carpet or reduce other environmental hazards so the recipient won’t have to make as many visits to a health care provider.
The transformation goes live on July 1.
“What is essentially happening, for those that don’t follow closely, is the Medicaid insurance program going forward is going to be administered by private insurance plans,” Cohen said.
The process for choosing the private plans has happened, and if someone did not select a plan, DHHS made sure the recipient was enrolled in one anyway.
“During the month of June is when they are getting in touch with their new plan,” Cohen said. “That is still happening right now. So we want to make sure if beneficiaries have questions, one, they can call their doctor that they’ve seen or they can call our Medicaid helpline and we can be sure to answer their questions.”
Have issues with your Medicaid plan? Call: 1-833-870-5500 (TTY: 1-833-870-5588). The call is toll free.
Policies and parameters are in place, Cohen said, to protect beneficiaries in the early months of the transformation.
“If they don’t like the plan, they either chose, or we enrolled them in, they can change for up to 90 days,” Cohen said. “There’s a lot of flexibility to both protect our doctors and our hospitals in this change, as well as our beneficiaries, and give folks flexibility so hopefully this can be a smooth transition.”
Coronavirus by the numbers
According to NCDHHS data, as of Thursday afternoon:
- 13,246 people total in North Carolina have died of coronavirus.
- 1,007,273 have been diagnosed with the disease. Of those, 548 are in the hospital. The hospitalization figure is a snapshot of people hospitalized with COVID-19 infections on a given day and does not represent all of the North Carolinians who may have been in the hospital throughout the course of the epidemic.
- 985,048 people who had COVID-19 are presumed to have recovered. This weekly estimate does not denote how many of the diagnosed cases in the state are still infectious. Nor does it reflect the number of so-called “long-haul” survivors of COVID who continue to feel the effects of the disease beyond the defined “recovery” period.
- To date, 13,455,767 tests have been completed in North Carolina. As of July 7, 2020, all labs in the state are required to report both their positive and negative test results to the lab, so that figure includes all of the COVID-19 tests performed in the state.
- People ages 25-49 make up the largest group of cases (39 percent). While 14 percent of the positive diagnoses were in people ages 65 and older, seniors make up 82 percent of coronavirus deaths in the state.
- 164 outbreaks are ongoing in group facilities across the state, including nursing homes and correctional and residential care facilities.
- As of Wednesday, 163 COVID-19 patients were in intensive care units across the state.
- As of June 9, 4,600,568 North Carolinians have received at least one dose of the coronavirus vaccine.