Department

Department of Population Health Management and Policy

Document Type

Poster

Publication Date

4-17-2026

Abstract

Background: North Carolina’s Care Management for High-Risk Pregnancy (CMHRP) program provides community-based care management to Medicaid-enrolled pregnant individuals with high-risk medical conditions or health-related social needs. Obstetric providers complete a standardized screener, with eligible beneficiaries referred to the CMHRP program housed in Local Health Departments (LHDs). While prior studies demonstrate positive maternal health outcomes, limited evidence exists on implementation mechanisms and contextual barriers.

Methods: This analysis represents the quantitative phase of a mixed-methods study. A cross-sectional survey was completed by 42 CMHRP stakeholders representing 50 North Carolina counties, including care managers (45.2%), administrators (28.6%), nurses, and social workers (7.1%). The 68-item instrument assessed program implementation, organizational and external context, workforce capacity, implementation processes, and outcomes using the Consolidated Framework for Implementation Research (CFIR) and RE-AIM frameworks. Likert scale responses were supplemented with open-ended questions.

Results: CMHRP demonstrated exceptionally strong implementation. All respondents agreed that the program improves health outcomes, aligns with departmental missions, and is acceptable to staff and clients. Workforce commitment was high, with 100% reporting motivation to participate and 97.6% reporting adequate knowledge and skills. However, sustainability concerns emerged: only 73.8% believed the program would be sustained long-term, 66.7% found per-member-per-month reimbursement rates reasonable, and 66.7% reported timely referrals. Qualitative responses identified funding inadequacy, Medicaid policy uncertainty, rural access barriers, and data-sharing limitations.

Conclusions: CMHRP is a highly valued and well-implemented program, but faces sustainability risks. Findings underscore the need for policy action to preserve the LHD-based model, strengthen reimbursement, standardize referrals, and expand equitable access for all populations.

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