Date of Award

4-1-2026

Embargo Period

4-9-2026

Document Type

Dissertation

Degree Name

Doctor of Health Administration

Department

Health Administration

College

College of Health Professions

First Advisor

Elinor Borgert

Second Advisor

Daniel L. Brinton

Third Advisor

Alicia Primus

Abstract

North Carolina became the 41st state to expand Medicaid under the Affordable Care Act. The bipartisan expansion addressed longstanding challenges; however, little is known about how Local Health Departments (LHDs) adapted to this policy change, especially in the 24 months following expansion. This study sought to fill that gap by documenting the perspectives of LHD Directors in North Carolina utilizing a ten-question REDCap survey with closed- and open-ended questions. Purposeful sampling targeted all 86 LHD Directors. Data was collected anonymously between November 2025 and January 2026. Descriptive and thematic analyses were conducted. Thirty LHD Directors completed the survey, which yielded a response rate of 35%. Their responses indicated that, in preparation, departments implemented community outreach and enrollment campaigns (40%) and aligned services with anticipated Medicaid needs (33%). Prior to expansion, all respondents’ departments offered Medicaid-billable preventative services, with many also providing maternal health (80%) and chronic disease management (60%). Following expansion, directors reported expanding preventative (63%), maternal health (40%), and chronic disease services (36%), though 26% reported no significant service expansion. While respondents cited improved access to care and coverage as key benefits, financial impacts were mixed and often accompanied by administrative burdens and billing challenges.

Rights

Copyright is held by the author. All rights reserved.

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