Equitable HEALTH Systems

What we know: North Carolina is currently engaged in two large-scale efforts to shift the way Medicaid pays for health care. The first is changing to Medicaid managed care, where private insurance companies, instead of the state, manage reimbursement of health care services for Medicaid members. Launched in 2021, the shift to Medicaid managed care resulted in approximately 1.7 million people experiencing a change to their insurance.

The second change is an experiment called the Healthy Opportunities Pilots. Launched in 2022, the Healthy Opportunities Pilot regions use Medicaid dollars to pay community-based organizations to provide services, such as housing and food, to address social determinants of health. We want to make sure that the organizations most connected to the people who need housing and transportation are able to participate in this pilot project. Achieving greater equity in health outcomes will require genuine partnership between hospitals and health systems and the community organizations that are embedded in underserved areas or led by residents with low incomes.

What we do: We work to ensure that these changes narrow racial disparities in health outcomes and improve the health of people whom the system has too often overlooked. We know the power is in community. We focus on understanding the experiences of Medicaid members by creating strong feedback loops with health system organizations. We also fund advocacy efforts, so Medicaid members have a voice in Medicaid shifts, and we fund research to collect and analyze data on Medicaid reform to understand the impact of Medicaid transformation on residents with low incomes. Finally, we are investing in the capacity of community organizations to collaborate with one another and participate in the Healthy Opportunities Pilots.

What we know: As the health system shifts to new payment models, we know that financially vulnerable residents, including the uninsured and underinsured, will suffer disproportionately from a lack of access to care. Given this transition and the COVID-19 pandemic, it is especially important to ensure the continued viability of the state’s health care safety net system.

What we do: During the implementation of Medicaid-managed care in North Carolina, we are focused on ensuring safety net providers, including federally qualified health centers, free and charitable clinics, rural health centers, and public health departments, have the capacity to pivot with new payment systems. We also invested in the North Carolina Institute of Medicine’s Task Force on the Future of Local Public Health to better understand how our public health system can be strengthened moving forward.