February 28, 2019
As a part of the Medicaid 1115 waiver application, NC DHHS submitted a “Healthy Opportunities” pilot. The pilot was approved along with the Medicaid 1115 waiver. This pilot brings an exciting prospect for achieving an important aspect of whole person care because it allows for Medicaid/Health Choice reimbursement in four areas of Social Determinants of Health (SDOH): housing, transportation, food insecurity and interpersonal violence/toxic stress. Very limited Medicaid reimbursement is currently available for these types of services, yet studies have proven that addressing health disparities including social determinants of health can save money and improve outcomes. A 2011 study by The Joint Center for Political and Economic Studies found that $230 billion in direct medical care expenditures between 2003 and 2006 were excess costs due to socially determined health inequalities for minorities. NC DHHS will identify two to four geographic areas of the state “to test evidence-based interventions designed to improve health and reduce costs by directly addressing housing instability, transportation insecurity, food insecurity, interpersonal violence and toxic stress for eligible Medicaid enrollees.” Framework for Pilot NC DHHS unveiled the framework for the Healthy Opportunities pilot in a recent webinar. NC DHHS will contract with a limited number (up to 4) of Lead Pilot Entities. These organizations are expected to have (a) experience directly providing relevant non-medical services or working closely with organizations that provide such services; (b) strong, longstanding relationships in the proposed Pilot geographic area with a variety of human service organizations; (c) expertise in providing services in a culturally competent manner; and (d) the commitment and expertise to strengthen the capacity of human service organizations to work effectively with healthcare systems and providers. The Lead Pilot Entities will then develop networks of Human Service Organizations (HSOs). The HSOs are community-based and social service agencies. Care Managers will play a key role in identifying Medicaid/Health Choice beneficiaries who can benefit from participating in the pilot. They will look for the following physical/behavioral health risk factors (varies by population):
• Adults (such as two or more chronic conditions).
• Pregnant women (such as multifetal gestation).
• Children, age 0-3 (such as a baby that was in a neonatal intensive care unit).
• Children, age 0-21 (such as experiencing three or adverse childhood experiences).
The State is collaborating with the Foundation for Health Leadership and Innovation to implement a statewide tool, NCCARE360, to serve as a platform to (i) directly connect patients to community resources, and (ii) track and monitor referrals. They have also contracted with the UNC Cecil B. Sheps Center to conduct an evaluation of the pilot. New service definitions will be developed. Below is a list of the federally-approved pilot services by category of SDOH: Housing: Housing and Tenancy Supports Housing Quality and Safety Improvement Services Legal Assistance Securing Housing Payments Short-Term Post-Hospitalization Food Insecurity: Food Support Services Meal Delivery Services Transportation: Non-emergency health-related transportation Interpersonal Violence (IPV)/Toxic Stress: Interpersonal violence-related transportation IPV and parenting support resources Legal Assistance Child Parenting Support
Request for Information (RFI) Published
The webinar also kicked off a Request for Information (RFI) in which NC DHHS is seeking design feedback and quantitative data for the pilot. Comments are due to NC DHHS by 2 p.m. EST on March 15, 2019.
Most of the services listed above are already being provided in North Carolina in some way. Much of it is through non-profit organizations that receive private funding and that create structures for the service. This formal process of the RFI is partially focused on obtaining accurate qualitative and quantitative data on who likely Human Service Organizations are, what is currently being offered and the cost related to that service. NC DHHS also uses the RFI process to seek feedback from Medicaid beneficiaries and other interested stakeholders. They noted in the recent webinar that organizations do not have to answer every question in the RFI. NC DHHS will use the feedback they receive to design the full pilot that they anticipate beginning by the end of 2020. NC DHHS anticipates publishing the Request for Proposals to identify the Lead Pilot Entities by mid-2019 and awarding those contracts by the end of 2019. Life Expectancy by Zip Code Robert Wood Johnson Foundation provides an interactive tool that will tell you the average life expectancy in your zip code: whereyouliveaffectshowlongyoulive.html. The RWJF site states, “…where we live can have an even greater impact. Improving health and longevity in communities starts with ensuring access to healthy food, good schools, affordable housing, and jobs that provide us the resources necessary to care for ourselves and our families—in essence, the types of conditions that can help keep us from getting sick in the first place.