Research: N.C. Medicaid SDOH Pilots Led to Reduced Spending
North Carolina’s efforts to address people’s social needs with services such as food, housing, and transportation through Medicaid led to less spending over time compared to what would have been expected otherwise.
That’s the conclusion of an evaluation led by Seth A. Berkowitz, M.D., M.P.H., associate professor and section chief for research in the division of general medicine and epidemiology in the UNC School of Medicine. These findings were published recently in the Journal of the American Medical Association.
The Centers for Medicare and Medicaid Services (CMS) approved the Healthy Opportunities Pilots (HOPs) in 2018 as part of the state’s waiver to transition to Medicaid managed care.
The state said the regional pilot projects marked the nation’s first comprehensive program to test evidence-based, non-medical interventions designed to reduce costs and improve the health of Medicaid beneficiaries.
Encouraged by early success of the program, the North Carolina Department of Health and Human Services (NCDHHS) renewed a federal 1115 waiver in October 2023, which included a request to allow expansion of Healthy Opportunities services statewide. The federal government authorized up to $650 million in Medicaid funding for the Pilots over five years.
“What I think is exciting about the findings is that they support the underlying idea of the Healthy Opportunities Pilots — that by addressing health-related social needs, the Medicaid program can improve the health of its beneficiaries,” Berkowitz said in a statement.
In their evaluation, Berkowitz and his study co-authors analyzed North Carolina Medicaid data from March 2021 through November 2023. They compared 13,227 HOP enrollees with 73,469 Medicaid recipients who reported having a health-related social need but were not eligible for HOP due to their county of residence.
Spending for HOP participants increased initially during the first month of enrollment, which may have been related to the reasons people enrolled in HOP in the first place, but over time spending trended downward by an average of $85 per beneficiary per month. After approximately 8 months of enrollment in HOP, monthly spending was about what it would have been in the absence of HOP, with lower spending thereafter.
