10 Contracts with managed care organizations (MCOs) and accountable care organizations (ACOs) also create opportunities for health care payers to coordinate medical and nonmedical services more closely. Section 1115 waivers, for example, allow states to modify Medicaid coverage, payment, and other requirements, which enables them to address a more robust set of needs than traditional clinical care. State Medicaid programs offer several flexibility opportunities that allow states to meet the needs of their residents. 9 Medicaid is a safety net program that provides flexibility for states 8 Furthermore, the Affordable Care Act’s Medicaid expansion, which provided Medicaid coverage to 13 million additional adults, has led to fewer public safety offenses, fewer evictions, and reduced medical debt. Medicaid coverage is associated with increased access to care and preventive services, improved health status, decreased hospital and emergency department use, and decreased mortality rates. 7 This report provides background on the Medicaid program and considers the merits of the Healthy Opportunities Pilots program. To respond to the unmet social needs affecting residents’ health, North Carolina has developed a pilot program, the Healthy Opportunities Pilots, to leverage opportunities for flexibility offered by the Centers for Medicare and Medicaid Services (CMS) that allow state governments to use Medicaid dollars to address social determinants of health. Nearly 1 in 2 women in North Carolina have experienced intimate partner violence.In North Carolina, 1 in 5 North Carolina children live in food-insecure households, and nearly 1 in 4 have had adverse childhood experiences, potentially traumatic events that occur in childhood.North Carolina has the eighth-highest food insecurity rate among all U.S.More than 1.2 million North Carolinians are unable to access affordable housing.4 This report considers the health landscape in North Carolina, where many residents have social needs that put them at high risk of health inequities: 5 Intersecting identities such as race, gender, sexual orientation, and immigration status further compound these social needs. Lower-income people often face social and structural barriers to achieving health, including food and housing insecurity access to quality education and access to clean air, land, and water.
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