WASHINGTON, DC – September 14, 2022 – The Healthy Opportunities Pilots is a new federal pilot program that focuses on improving the health of Medicaid beneficiaries. It was launched earlier this year. The program incorporates evidenced-based non-medical interventions related to food, transportation, housing assistance, interpersonal safety and toxic stress reduction. The federal government has dedicated up to $650 million of additional Medicaid funding over the next five years. The North Carolina Department of Health and Human Services will be responsible for implementing this program. The program will maintain equity and timeliness of the operations while strengthening the capacity for each community to provide services. The pilot study will evaluate the effect of the interventions on improving health outcomes and reducing healthcare costs. Upon a successful review, the pilot program will be expanded throughout the state.
In 2018, the federal Center for Medicare & Medicaid Services approved a proposal by the state of North Carolina for a transition from a fee-for-service delivery system for Medicaid recipients to a managed care program in order to improve health outcomes and reduce the cost of health care. As part of this transition plan, the federal government will allow the state to begin a pilot program to study the economic savings and health improvements that result from incorporating evidenced- based non-medical interventions. Eighty percent of a person’s health is determined by social and environmental factors.
The pilot program will take place in 3 geographic regions in North Carolina. One is in the western part of the state including Buncombe County and the other 2 are located in the eastern part of the state. There are 29 non-medical interventions that will be evaluated. These services will be provided to eligible N.C. Medicaid recipients who live in a Pilot region with at least one health condition or social risk factor as determined by their Medicaid Health Plan. Payment for these goods and services will be covered by the funding for the pilot program.
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