NC DHHS’ 1115 Waiver Renewal Approved to Continue and Expand NC Healthy Opportunities Pilots and Other Programs
Photo credit: Thanakorn Lappattaranan via Vecteezy
Via the NC Dept. of Health and Human Services:
In 2018, NCDHHS won approval from the Federal government to try an innovative approach to improving North Carolinian’s health. Recognizing that health doesn’t just happen at the doctor’s office or in a hospital, the Centers for Medicare/Medicaid Services (CMS) under the first Trump Administration, gave NCDHHS the flexibility through an 1115 Medicaid waiver to invest in housing, food, transportation and more for high-needs Medicaid recipients. The premise behind this was a simple one: people stay healthier, and the state saves money in the long run.
The North Carolina General Assembly saw the value in this approach and has supported these efforts by funding the Healthy Opportunities Pilots. Earlier this year we got good news, it’s working. Participants had fewer emergency department visits and less inpatient hospitalizations, and the state is spending about $85 less in medical costs per participant per month. And now, in recognition of these strong results, CMS has just approved a new 1115 waiver renewing the flexibilities behind this success and expanding more opportunities to build on these innovations.
This approval is a necessary, but not a final, step to helping more North Carolinians stay healthy and further bending the healthcare cost curve for the state. With this approval, we now have a menu of options for North Carolina to potentially take advantage of. NCDHHS will meet with stakeholders, partners, and most importantly legislators, to discuss what opportunities are now available and how we may be able to come together to implement them. An overview of the key components of this new 1115 waiver approval are below:
Allows for Healthy Opportunities Pilots that invest in non-medical drivers of health like food, transportation and housing to be taken statewide (beyond the current three regions),
Opens up access for people who are incarcerated to get NC Medicaid health coverage up to 90 days prior to their release providing them critical health services and helping to break the expensive cycle of incarceration,
Enables more behavioral health resources for North Carolinians and boosts the behavioral health workforce,
Extends federal authority for North Carolina’s successful Medicaid Managed Care program,
Makes it possible for children to remain covered by NC Medicaid for longer periods of time, reducing burdensome paperwork for families and counties, and
Continues availability to evidence-based substance use disorder treatments for Medicaid beneficiaries while they are in a qualifying facility.
Since the Healthy Opportunity Pilots launched in three rural regions in 2022, North Carolina has served more than 26,000 high-needs Medicaid enrollees to keep them healthier and prevent illness rather than just waiting to treat it. And we’ve proven it’s more cost-effective.
The community-based organizations that we worked with to implement the Healthy Opportunities Pilots have been essential and excellent partners, though none of this past success would have been possible without the support from the General Assembly. We’re proud these shared accomplishments have improved lives and laid the foundation for us to partner again and make an even bigger impact. We will be sharing this news of the approval from CMS with other interested parties, which will generate excitement as we contemplate how to move forward together. We will follow up soon to provide additional details on the 1115 waiver approval and what steps we could begin to take.
Thank you again for your support to improve the health and well-being of all North Carolinians.
