How North Carolina Is Using Medicaid To Address Social Determinants of Health

Using a Section 1115 waiver, North Carolina has undertaken a major effort to put Medicaid dollars toward evidence-based interventions to address social determinants of health: the Healthy Opportunities Pilots program.

To qualify for the Healthy Opportunities Pilots program, participants must demonstrate at least one health risk factor and one social risk factor.

Healthy Opportunities Pilots program funds are also used to build capacity, establish network leads, and support human service organizations in delivering social services.²² Network leads are entities with deep community roots that “facilitate collaboration and build partnerships across healthcare payers and human service providers.”²³ One network lead operates in each pilot region. To deliver their services, human service organizations contract with their region’s network lead.

Addressing unmet nonclinical needs may confer savings, potentially appeasing state budgetary concerns.²⁴ If the North Carolina program sees savings and/or improved outcomes in any region, it may become much easier for other regions in the state—and other states—to replicate the program. If the pilot program is successful and cost effective, the CMS can decide to expand its duration and scope.

For transportation, the program will pay up to $102/month for health-related public transportation costs and up to $203/month health-related private transportation.