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Healthy Opportunities Pilot Program in North Carolina Receives $650 Million in Funds

The new pilot program addresses social determinants of health

April 6, 2022  – North Carolina is providing $650 million in funds to the Healthy Opportunities pilot program. This program will reimburse social service provider organizations for interventions that address social determinants of health (SDOH) for Medicaid beneficiaries in the state. 

Social determinants of health are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. The Healthy Opportunities pilot program will address SDoH like housing, food, transportation, toxic stress, and interpersonal safety. 

The services will launch across all three pilot regions in stages. On March 15, 2022, food services went live and providers are able to start being reimbursed for services. Starting May 1, 2022, housing and transportation services will be available across all pilot regions, and on June 15, 2022, interpersonal safety and cross-domain services will be available.

Steps for Reimbursement

Steps for referral to reimbursement have been laid out by the North Carolina Department of Health and Human Services (NCDHHS). The first step is for a care manager to enter a referral into the state’s NCCARE 360 platform. After the data is entered into NCCARE 360, the system will send an alert to a participating provider organization that offers the needed services. 

After an organization accepts the referral, they are responsible for connecting with the member to deliver the services. Once the requested services are delivered, the social service provider organization must submit an invoice to the beneficiary’s MCO. The MCO will then reimburse the social service provider organization directly. 

Lead Agencies for Healthy Opportunities Pilot

Following a competitive request for proposals (RFP), in November 2019, the NCDHHS awarded three lead agencies contracts. 

As the map below shows, Access East, Inc., Community Care of the Lower Cape Fear, and Impact Health will serve the various regions throughout the state.

With the first of three service categories launching, only time will tell how well the Healthy Opportunities pilot program works to address social determinants of health in care plans.

To learn more about the Healthy Opportunities pilot program, click here.

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