Healthy Opportunities Pilots

Announcement: Healthy Opportunities Pilots Suspension

May 28, 2020—To support North Carolina health care and human service providers as they focus all available resources to respond to the COVID-19 pandemic, the Department of Health and Human Services has suspended the evaluation of the Healthy Opportunities Lead Pilot Entity proposals. Due to the uncertain nature of the pandemic, a new award date has not yet been determined. Lead Pilot Entity Offerors will be notified when additional information is available. 

Addressing the unmet resource needs of North Carolinians remains a key priority of the Department. This suspension is related only to the Healthy Opportunities Pilots and does not impact other Healthy Opportunities efforts, such as the NCCARE360 rollout and Community Health Worker initiative:

• NCCARE360 will continue to serve as the network for connecting health care and human service organizations to a shared technology platform that allows for a coordinated, community-oriented, person-centered approach to delivering care in North Carolina. Onboarding to the platform and training will continue as planned. By participating in the network, providers can continue to electronically connect those with identified needs to community resources and allow for a feedback loop on the outcome of that connection. This solution ensures accountability around services delivered, provides an “any door” approach, closes the loop on every referral made and reports on outcomes of that connection. 
• The North Carolina Community Health Worker Initiative will offer the next semester of coursework at educational institutions in the North Carolina Community College System in spring 2021. The course will provide individuals with the required knowledge, tools and resources to become recognized as a certified Community Health Worker in North Carolina working in a variety of health care and community settings (health departments, hospitals, federally qualified health centers, clinics, faith-based organizations, etc.). The nine core competencies covered in the course include communication, capacity building, service coordination, interpersonal advocacy, outreach and personal/professional skills. Students will also learn how to use NCCARE360 to connect community members to health and human service resources. 

As a part of North Carolina’s Section 1115 demonstration waiver, North Carolina received authority from the Centers for Medicare & Medicaid Services to conduct the Healthy Opportunities Pilot Program. The Pilots will create a unique opportunity to test the impact on health outcomes and health care costs by using Medicaid funds to pay for non-medical services specifically related to food, housing, transportation and interpersonal safety. Additionally, the Pilots will provide a mechanism for payers, providers and human service organizations (HSOs, e.g., community-based organizations or social service agencies) to have the tools, infrastructure and financing to integrate non-medical services into the delivery of health care for eligible Medicaid members.

Questions regarding the procurement of Lead Pilot Entities and the suspension of awards can be directed to Medicaid.Procurement@dhhs.nc.gov. Press inquiries can be directed to news@dhhs.nc.gov.
 

About the 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 up to three 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.

Procurement of Lead Pilot Entities

On Nov. 5, 2019, the North Carolina Department of Health and Human Services (DHHS) released a Request for Proposals (RFP) for the Healthy Opportunities Pilots that will be implemented as a part of Medicaid managed care. 
 
The RFP is to select Lead Pilot Entities (LPEs) through a competitive procurement process and enter into contracts with LPEs to operate elements of the Healthy Opportunities Pilot program. LPEs will contract directly with other organizations to build a network of Human Services Organizations to deliver Pilot services in their geographic area.
 
The deadline to submit proposals was Feb. 14, 2020, at 2 p.m. The Department received proposals from nine Offerors. Please see the list of Healthy Opportunities Lead Pilot Entity Offerors for a list of organizations that submitted a proposal. The Department anticipates that LPEs will be selected in May 2020 and Pilot service delivery will begin in the spring of 2021. 

The RFP and all related information is available on the Requests for Proposals (RFPs) and Requests for Information (RFIs) page under REQUEST FOR PROPOSAL FOR HEALTHY OPPORTUNITIES LEAD PILOT ENTITY. 

Lead Pilot Entities Request for Proposals Fact Sheet - Nov. 5, 2019

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