The Collaborative Care Model (CoCM) for Treating Pediatric Behavioral Health: A Case Study of Implementation and Financing in North Carolina

Introduction: In the United States, pediatric mental health care faces substantial barriers, including limited access to care and high costs. This study investigates the implementation and reimbursement challenges and facilitators of the Collaborative Care Model (CoCM) within North Carolina's pediatric Medicaid population, providing insights into state-specific adoption and financial strategies. The objective of this study was to explore the barriers and facilitators affecting the use and reimbursement of CoCM for pediatric Medicaid beneficiaries in North Carolina, with a focus on evaluating the state's innovative reimbursement strategy. Methods: A qualitative case study design was employed, focusing on North Carolina Medicaid's implementation programming and reimbursement for CoCM. Data were collected through document review and semi-structured interviews with key stakeholders, including state Medicaid officials, implementation experts, and members of the North Carolina Collaborative Care Consortium. Thematic analysis was conducted to identify key barriers and facilitators. Findings: Significant barriers included the initial high start-up costs, inadequate provider training, and a lack of understanding of CoCM's operational requirements. Facilitators included increased Medicaid reimbursement rates and robust state-level support through resources and technical assistance. Notably, the enhanced reimbursement rates facilitated initial engagements but were insufficient alone to ensure sustained implementation. Discussion/Implications: While North Carolina's increased reimbursement rates for CoCM are a positive step, comprehensive training, technical support, and addressing operational challenges are critical for broader adoption. These findings suggest that a multi-faceted approach, beyond financial incentives, is essential for the successful integration of CoCM into pediatric primary care settings. The study underscores the necessity for targeted strategies to overcome barriers and enhance the scalability of CoCM, particularly within pediatric Medicaid populations.