In March 2022, Medicaid launched the Healthy Opportunities Pilot, a program to support up to 20,000 low-income North Carolina residents. The program, a $650 million initiative, aims to test whether Medicaid funding should be used differently to better support the social problems that affect people’s health.
If you’re a North Carolina low-income earner, you may be eligible to participate in the program, which is currently rolling out across 33 counties. Chat with your doctor to help understand if you’re eligible for the program.
Dr. Elizabeth Tilson, the chief medical officer of North Carolina, said it’s about buying health, not healthcare access. The approach is backed up by research by The Commonwealth Fund, whose mission is to promote a high-performing health care system, particularly for society’s most vulnerable. Their findings show up to 80% of an individual’s health is determined by access to healthy food, adequate transportation, and safe housing.
North Carolina is the first state to run the pilot, which seeks to determine the level of social services it takes to improve community health. The pilot tests whether Medicaid Managed Care is the right step to getting people healthier by providing better access to healthy food, housing, and transportation. The initiative will also seek to measure any cost savings in medical care.
The program allows doctors to refer patients to the program who show signs of poor nutrition. Patients must meet the state’s eligibility rules, which include being a NC Medicaid Managed Care member living in a pilot region, with at least one qualifying social risk factor and one medical condition.
Once approved, the referral is sent to participating community groups and food banks that distribute free fresh produce to the patient. Each patient will also be directly contacted so they understand how the system works and what they’ll be receiving. A typical delivery may include a food box containing fresh local produce, grains, and peanut butter.
Medicaid will cover the cost of all the food boxes delivered by participating food banks and doctors will also be notified when the delivery has been made, so they can follow up with patients to support their ongoing care.
The length of the pilot program has yet to be confirmed. Outcomes are being evaluated by independent researchers to determine the impact on patient health. Updates will be made throughout the pilot based on ongoing analysis to improve the process.
The food part of the program is already well underway, and help with transportation and housing is due to begin in May. Eligible patients can seek assistance helping to pay for a security deposit or to assist with paying their first month or rent. From June, anyone affected by domestic violence can also seek help.
We recommend chatting to your doctor as the first step or getting in touch with the NC Department of Health and Human Services for more information about the program. The program is targeting high-risk NC Medicaid Managed Care members.
If you have any questions relating to Medicare or Medicaid, our local NC Medicare agents can help. Get in touch with us today, and we can help you arrange the best health coverage for your needs.