N.C. Chooses Three Regions for Medicaid Healthy Opportunities Pilots

June 15, 2021
As state prepares shift to Medicaid managed care, pilots will test evidence-based, non-medical interventions designed to reduce costs, improve health of Medicaid beneficiaries

The North Carolina Department of Health and Human Services has selected three regions of the state to pilot a systematic approach to integrating and financing non-medical services that address housing stability, transportation access, food security and interpersonal safety into the delivery of healthcare for Medicaid beneficiaries.

On July 1, North Carolina will launch a major transition to Medicaid manage care, which will impact how millions of North Carolinians receive care. Among the goals are improving access to preventive health and wellness programs and driving down long-term healthcare costs.

The state said the regional pilot projects will mark the nation’s first comprehensive program to test evidence-based, non-medical interventions designed to reduce costs and improve the health of Medicaid beneficiaries. The regions chosen include two in eastern North Carolina and one in western North Carolina:

• Access East Inc.: Beaufort, Bertie, Chowan, Edgecombe, Halifax, Hertford, Martin, Northampton, Pitt counties;
• Community Care of the Lower Cape Fear: Bladen, Brunswick, Columbus, New Hanover, Onslow, Pender counties; and
• Dogwood Health Trust: Avery, Buncombe, Burke, Cherokee, Clay, Graham, Haywood, Henderson, Jackson, Macon, Madison, McDowell, Mitchell, Polk, Rutherford, Swain, Transylvania, Yancey counties.

The Centers for Medicare and Medicaid Services (CMS) approved the Healthy Opportunities Pilots in 2018 as part of the state’s waiver to transition to Medicaid managed care.   "The Healthy Opportunities Pilot will integrate the services that address these non-medical drivers of health and build the evidence base to identify which services are most effective at improving a person’s health and lowering their health care costs, said DHHS Secretary Mandy K. Cohen, M.D., in a statement.

To be eligible for and receive pilot services, NC Medicaid Managed Care members must live in one of the three selected regions, have at least one qualifying physical or behavioral health condition, and have one qualifying social risk factor.

The federal government has authorized up to $650 million in Medicaid funding for the pilots, which will cover the cost of delivering the non-medical services and, in the first two years, support capacity building for human service organizations needed to effectively deliver non-medical services in a health care context.

The department will work with the Healthy Opportunities Network Leads (formerly referred to as Lead Pilot Entities), prepaid health plans (PHPs), care management entities and human service organizations to implement the pilot program. Human service organizations are community-based organizations and social services agencies that will deliver pilot services and be overseen by Healthy Opportunities Network Leads.

The department anticipates that pilot service delivery will begin in the spring of 2022.

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