Lessons Learned from the Implementation of Housing Support Services in North Carolina Medicaid’s Healthy Opportunities Pilots

Publications

Oct 30

The lower half of a pair of legs and feet in dark pants and shoes standing on gray painted plank decking in front of a coconut fiber doormat that says "Home," with a red heart taking the place of the letter O. — Photo by Kelly M Lacy

The Duke-Margolis Institute for Health Policy has just published a Community Fact Sheet summarizing the findings of their research into the development and implementation of, and lessons learned from, the provision of housing support services to NC Medicaid recipients via the Healthy Opportunities Pilots (HOP).

The original paper, “Addressing Housing-Related Social Needs Through Medicaid: Lessons From North Carolina’s Healthy Opportunities Pilots Program,” (Huber K, Nohria R, Nandagiri V, et al.), was published in Health Affairs Vol. 43, No. 2: Housing & Health, in Feb 2024.

Impact Health (Network Lead for the Western NC HOP) is a long-standing partner of the WNC Health Policy Initiative. Their foundational work in the HOP program has been recognized both within North Carolina and nationally as a successful model for addressing social needs to reduce health care costs and improve both the health outcomes and quality of life of recipients.

Paper abstract:

North Carolina Medicaid’s Healthy Opportunities Pilots program is the country’s first comprehensive program to evaluate the impact of paying community-based organizations to provide eligible Medicaid enrollees with an array of evidence-based services to address four domains of health-related social needs, one of which is housing. Using a mixed-methods approach, we mapped the distribution of severe housing problems and then examined the design and implementation of Healthy Opportunities Pilots housing services in the three program regions. Four cross-cutting implementation and policy themes emerged: accounting for variation in housing resources and needs to address housing insecurity, defining and pricing housing services in Medicaid, engaging diverse stakeholders across sectors to facilitate successful implementation, and developing sustainable financial models for delivery. The lessons learned and actionable insights can help inform the efforts of stakeholders elsewhere, particularly other state Medicaid programs, to design and implement cross-sectoral programs that address housing-related social needs by leveraging multiple policy-based resources. These lessons can also be useful for federal policy makers developing guidance on addressing housing-related needs in Medicaid.

Community Fact Sheet (pdf)

Full Paper (website)