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March 31, 2026
The NC Medicaid Managed Care Ombudsman: A Robust and Effective Beneficiary Support System
Miriam Delaney Heard, Elizabeth Edwards, and David Machledt Issue Brief
The North Carolina Medicaid program implemented a model beneficiary support system when it transformed its Medicaid program to comprehensive managed care starting in 2021. This program, called the North Carolina Ombudsman Program, was operated by legal services organizations and had several key features that made an important asset for…
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March 26, 2026
Lessons Learned from North Carolina’s MCPAR Reports
Daniel Young Issue Brief
States must submit Medicaid Managed Care Program Annual Reports (MCPARs) annually for each of their managed care programs. Examining the MCPARs for one state, North Carolina, reveals how the role and structure of MCPARs as oversight tools are helpful, but there are also ways to make them more useful…
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January 2, 2026
Federal AI Policy Threatens Prior Authorization Reform
Brit Vanneman Automated Decision-Making, Uncategorized
Automated systems play increasingly important roles in shaping access to health care services. Frequently, insurers use algorithms and artificial intelligence (AI) to route requests and make coverage decisions, fill records and forms, and even make recommendations about medical necessity. While automation can improve speed, relying too heavily on AI…
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December 11, 2025
Prior Authorization in Medicaid Series
Brit Vanneman Issue Brief
This issue brief series explores how prior authorization policies shape access to care in public health coverage programs, particularly Medicaid. The first brief introduces the fundamentals of prior authorization, how it operates for Medicaid beneficiaries, and the growing movement for reform. Future installments will explore the legal and policy…
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September 24, 2025
New Medicaid Work Requirements: How Managed Care Plans Can Help
Abigail Coursolle Uncategorized
Beginning January 1, 2027, OBBBA requires adults covered under the Medicaid expansion population to participate in mandatory work activities or show they are exempt. These work requirements will force Medicaid beneficiaries to show that they participate in one or more required work-related activities for 80 hours per month. Activities…
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July 29, 2025
Revisiting Managed Care Sanctions
Daniel Young Issue Brief
This issue brief is part of the National Health Law Program’s ongoing work on accountability in Medicaid managed care. It updates our research on Medicaid managed care sanctions by revisiting the states we profiled in 2022. We summarize recent sanctions content from the managed care websites of those states…
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The NC Medicaid Managed Care Ombudsman: A Robust and Effective Beneficiary Support System

Lessons Learned from North Carolina’s MCPAR Reports

Federal AI Policy Threatens Prior Authorization Reform

Prior Authorization in Medicaid Series

New Medicaid Work Requirements: How Managed Care Plans Can Help

Revisiting Managed Care Sanctions