CMS Approves Innovative Pilot Program to Address Social Determinants of Health as Part of North Carolina’s New Medicaid Waiver

Publication Year: 2018
Patient Need Addressed: Chronic Conditions, Food insecurity, Homelessness/housing, Transportation, Trauma
Population Focus: Medicaid beneficiaries
Intervention Type: Staff design and care management
Type of Literature: Grey
link: https://eymanlaw.com/cms-approves-innovative-pilot-program-address-social-determinants-health-part-north-carolinas-new-medicaid-waiver/
Abstract

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Insights Results

Overview of article

  • In October 2018, CMS approved a Section 1115 waiver for an innovative pilot in North Carolina designed to promote efforts to address the social determinants of health for high-risk, high-cost beneficiaries
  • The pilots will provide enhanced case management and other services to eligible individuals in the following 4 areas: 1) Housing: Including tenancy support and sustaining services, housing quality and safety improvement, access to legal assistance, support for a security deposit, and post-hospitalization assistance; 2) Food: Including food support services such as nutrition counseling and education, funding for nutrition provided through food banks for medical conditions, and meal delivery services; 3) Transportation: Including non-emergency health related transportation, such as public transit and private services (taxis, ride-sharing) for accessing the pilot services; and 4) Interpersonal Violence/Toxic Stress: Including transportation, support resources (including assisting individuals to transition out of traumatic situations), access to legal assistance, and child-parent support
  • To be eligible for pilot services, beneficiaries must meet at least one of a list of specified needs-based criteria (tied to health-related chronic or other conditions) and have one or more risk factors. The risk factors are: 1) Homelessness/housing insecurity; 2) Food insecurity; 3) Transportation insecurity; and 4) Being at risk of, witnessing or experiencing interpersonal violence

Key takeaways/implications

  • Moving forward, this pilot program could encourage other states to explore creative uses of the flexibility inherent in 1115 waivers to develop new approaches to addressing social determinants, and more broadly in fostering delivery system reform
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