Healthy Opportunities Pilots

The Healthy Opportunities pilots will test the impact of providing selected evidence-based interventions to Medicaid enrollees. Over the next five years, the pilots will provide up to $650 million in Medicaid funding for pilot services in two to four areas of the state that are related to housing, food, transportation and interpersonal safety and directly impact the health outcomes and healthcare costs of enrollees.

Importantly, the pilots will allow for the establishment and evaluation of a systematic approach to integrating and financing evidence-based, non-medical services into the delivery of healthcare. If shown to be effective after rigorous evaluation, the NC Department of Health and Human Services will look to systematically integrate pilot services statewide through Medicaid managed care.

Sign up for the Healthy Opportunities listserv to receive updates about the Healthy Opportunities pilots by emailing healthyopportunities@dhhs.nc.gov.

Stakeholder Feedback Requested

On July 15, 2019, NC released important technical documents for stakeholder feedback related to the Healthy Opportunities Pilots. The documents include:

1. Healthy Opportunities Pilots Service Definitions and Pricing Methodology: A request for feedback on detailed pilot service definitions and pricing information, especially from frontline human service providers. Stakeholder feedback on this document will inform the development of an equitable and transparent fee schedule for Pilot services. DHHS encourages stakeholders to use this template to provide feedback to healthyopportunities@dhhs.nc.gov by 5 p.m. Aug. 2, 2019.

2. Healthy Opportunities Lead Pilot Entity (LPE) Statement Of Interest and Supplementary Guidance: A request for a non-binding Statement of Interest (SOI) to bid from organizations interested in serving in the pilots as an LPE, plus more information about entities that may serve as an LPE. DHHS envisions that LPEs will serve as the essential connection between traditional healthcare and human service organizations and will play a crucial "behind the scenes" role by establishing a network of frontline human service providers to provide pilot services and connect that network to Pre-paid Health Plans. DHHS encourages potential LPE applicants to use this template to submit their SOI to healthyopportunities@dhhs.nc.gov by the updated deadline of 5 p.m. Aug. 12, 2019.

3. Healthy Opportunities Pilot LPE Statement of Interest Submissions: The compiled list of Statements of Interest (SOIs) will serve as a tool to promote community awareness and collaboration among organizations interested in bidding to serve as an LPE and other organizations (healthcare and human services organizations, among others) in its region. Healthy Opportunities is in the process of developing a request for proposals (RFP) to procure two to four LPEs through a competitive bidding process. DHHS anticipates releasing the LPE RFP in fall 2019 and selecting LPEs in early 2020.  As a reminder, the inability to submit an SOI does not preclude entities from submitting an RFP response. Submission of an SOI does not obligate an organization to submit a response to the LPE RFP and will not impact the evaluation of RFP responses. Please continue to check the Healthy Opportunities Website for updates and news.

Resources

Healthy Opportunities and Medicaid Transformation

Pilots Overview and Evaluation

Healthy Opportunities Pilots Fact Sheet

The Commonwealth Fund/Manatt Health Advisory Panel for the Healthy Opportunities Pilot Service Fee Schedule

Centers for Medicare and Medicaid Services Administrator Seema Verma’s article about North Carolina’s Medicaid transformation and Healthy Opportunities pilots

CMS Pilot Evaluation Design Approval Letter and Evaluation Design