N.C. Healthy Opportunities Pilot Participants Describe Impact
Earlier this year, the North Carolina Department of Health and Human Services announced it was expanding its Medicaid Healthy Opportunities Pilot (HOP) project, which addresses people’s social needs with services like food, housing, and transportation. During a recent webinar, Sarah Rideout, the leader of an organization that bridges healthcare and social services organizations for the initiative, described her group’s role.
Rideout is the HOP Program Director for one of the “network leads” in the program, the Community Care of Lower Cape Fear. Network leads serve as local anchors to build the capacity of community-based organizations to participate in Medicaid, including by distributing capacity-building funds and providing technical assistance and developing and managing a high-quality network of CBOs.
Speaking during a September 2024 Manatt Health webinar, Rideout said that an important goal in any community hub model is to ensure you're engaging with organizations that reflect the members in the community.
“You may have a small rural church or a food pantry that's deeply rooted and trusted in their community and do great things, but maybe they've never been invited to the table,” she said. “Participating in state- and federal-level grants or pilot programs requires a steep learning curve. There may be organizations who think HOP or other SDOH-type models feel insurmountable. A community hub organization can really help lift them up and create glide paths to get them there.”
Rideout explained that the network leads provide a space of education and support, and be tailored to the needs of the organizations they work with. “A lot of our community-based organizations (CBOs) have to become Medicaid vendors. They train to use a closed-loop referral and invoicing system. They connect with health plan EFTs [electronic fund transfers] and have to create reconciliation processes,” she said. “They also need to understand compliance and data privacy and security, budgeting and reporting. This is all in addition to building staffing models and using capacity-building to meet those service delivery needs while honing in on being sustainable.”
The network lead’s role is to educate CBOs on processes and policy changes. “We review invoices to ensure they're complete and accurate with all the supporting documentation, and that's before it goes to the health plan,” Rideout said. “As the pilot evolves, you can really drive performance for your network. For example, in the first year you're getting your feet under you. You're learning processes, tackling barriers, learning to collaborate across stakeholders who typically have never played together before. As the network lead, part of our role is to serve as a conduit and help support organizations work collaboratively. Once you get over that initial hump of implementation, a network lead can really help drive performance, and that help CBOs create efficiencies and move the needle when it comes to meeting metrics or KPIs, and then, of course, optimizing member experience.”
In addition to being a bridge to health plans, Community Care of Lower Cape Fear also collaborates with clinically integrated networks and care management entities. “We're a very data-driven network lead, so we all use a lot of data to help us understand where we are and how we can help performance, and that includes working with our care management entities and our health plan partners.”
Also speaking during the Manatt Health webinar was Reverend Blake Hart, executive director of the Haywood Christian Ministry, which joined the Healthy Opportunities Pilot program in November of 2022.
“I have never seen a program this effective at getting help into rural communities,” Hart said, “Some of the other programs that we have taken part in, we would be able to offer food assistance with $5,000 for a year, or do weatherization for five families in a year.” Then he gave a snapshot of his organization’s current caseload with Healthy Opportunities: “We’re offering case management to 95 families for housing navigation and security. We have 60 families that we're either delivering food boxes to or meals to, and 193 produce prescriptions are coming out of us every single month,” Hart said. “I used to talk about the rental assistance — first month's deposits, utility deposits and payments, those sort of things. Since 2022 that translates into just over, $1 million of direct money going into either home repairs, purchasing healthy goods for families, purchasing produce prescriptions.”
He noted that they have a local-first policy. “So that's not just money that's benefiting those families, but it's going into our local economy. In rural Western North Carolina, that's a significant impact when a small produce stand has received about $20,000 to $30,000 of produce purchases from us since our inception into that program.
He told one story about a Hispanic family that said otherwise would have been afraid to reach out for any assistance. But through this program, they were able to reach out and get healthy produce through the produce prescriptions into their household. They also were able to get humidity control and mold remediation to help with their children's asthma in their home. In the long term, they were able to find better housing that was more adequate for their family size.
“Another case involved a family we were first offering food boxes, but then learned that they were living out of their car,” Hart said. “We worked with that family over the months that it takes to find affordable housing in our area, to finally get them enrolled in Section 8 and to then get them into a house that was both healthy and safe for the parents and the child in the household.”
Elizabeth Tilson, M.D., State Health Director and the Chief Medical Officer for North Carolina, said, “One of the beauties of the 1115 Medicaid waiver was that we could use capacity-building dollars up front, so we were able to resource our network leads and our community-based organizations up front, so they could get the technology and staff people they needed up front, so they could start delivering services. Capacity building in our communities was huge and really, really important. We really wanted the services delivered by our local, community based organizations, When somebody from our church is delivering the food box to that person, it is creating that connectedness, it's pulling people in, and then we can start wrapping around more of those services.”
