Supporting the Implementation and Disseminating the Learnings of North Carolina's Healthy Opportunities Pilots

Supporting the Implementation and Disseminating the Learnings of North Carolina's Healthy Opportunities Pilots


 In October 2018, CMS approved North Carolina’s 1115 waiver to move the state’s Medicaid system from fee-for-service to a managed care program. A key part of this 1115 waiver is a groundbreaking demonstration project, the Healthy Opportunities Pilots, to pay for and deliver services to address unmet social needs in three regions across North Carolina. In the program, each pilot region’s Network Lead organization—with support from managed care plans in identifying patients, assessing needs, collecting data, and managing budgets—will oversee a network of local human service organizations to pay for and deliver evidence-based interventions that address unmet needs in food, housing, transportation, interpersonal safety and toxic stress. In July 2021, the Pilots officially began its capacity-building phase where $100 million is supporting the Network Leads to do things like establishing policies, hiring staff, and building their network of human service organizations. Service delivery is scheduled to launch in Spring 2022.

Project Overview

Given the substantial challenges that exist for integrating health and social services, however, there is need for timely and practical guidance. This project’s objective is to understand early real-world experiences in preparing for and implementing the Healthy Opportunities Pilots, in order to generate learnings and insights to improve the implementation of the Pilots, North Carolina’s broader Medicaid transformation, and similar initiatives by other states or payers to address social needs.

Following two expert stakeholder guiding committee convenings in the first year of the project with over 50 key stakeholders locally and nationally to guide our work, we are in the process of conducting our research. In June 2021, our team moderated a policy roundtable at the 2021 AcademyHealth Annual Research Meeting to discuss the Pilots, our work, and work occurring across the nation to address social needs through Medicaid. For the first stage of our work, we studied North Carolina’s COVID-19 Support Services Program—developed during the COVID-19 public health emergency to address multiple pandemic-related social needs—as it is informally seen as a smaller-scale preview of Pilots due to similarities in design and service provision. We partnered with one of the program’s largest grantees to analyze their program survey data and we completed interviews with 16 experts involved in every level of the COVID-19 Support Services Program statewide. We expect to publish findings in a policy brief in early 2022. By Summer 2022, we: will finish conducting all interviews about planning, building capacity, and early administration of the Pilots; will conduct and release 4 case studies on early innovators in the Pilots; will hold a focus group with NC Medicaid enrollees in the Pilots program; and will develop a summative, cross-cutting manuscript of findings for local and national policymakers.  

Our project is funded as part of the Robert Wood Johnson Foundation’s “Research in Transforming Health and Health Care Systems” program, which seeks to build the evidence base on the potential effects of policies or policy changes intended to transform health and health care systems. We are coordinating with the NC Department of Health and Human Services.

Duke-Margolis Team

Robert Saunders

Robert Saunders, PhD

Senior Research Director, Health Care Transformation
Adjunct Associate Professor
Senior Team Member
Margolis Core Faculty

William K. Bleser - Margolis headhot

William K. Bleser, PhD, MSPH

Assistant Research Director, Health Care Transformation for Population Health, Social Needs, and Health Equity
Senior Team Member
Anti-Racism and Equity Committee Member


Rebecca Whitaker, PhD, MSPH

Assistant Research Director
Senior Team Member
Anti-Racism and Equity Committee Member

Katie Huber

Katie Huber, MPH

Policy Analyst

James Zheng

James Zheng

2020 Margolis Intern
2021 Margolis Intern

Picture of Jasmine Masand

Jasmine Masand, (MPP '21)

Anti-Racism and Equity Committee Member

Additional Collaborators

Hannah Crook (former Duke-Margolis Staff member)

Michelle Lyn (Assistant Professor in Family Medicine and Community Health at Duke University)