The North Carolina Department of Health and Human Services (NCDHHS) remains dedicated under its’ Medicaid Managed Care efforts to improving the health of North Carolinians through an innovative, equitable, whole-person centered and well-coordinated system of care that addresses both medical and nonmedical drivers of health.
One approach to achieving the goals of NC Medicaid Managed Care is to support local capacity to overcome persistent health inequities by empowering and deploying community health workers (CHWs) and other care extenders to improve population health and support equitable health outcomes.
CHWs are frontline public health workers and trusted members of their communities who can serve as bridge builders between health and human services systems and communities, and serve as part of a broader team engaging Medicaid members and supporting their access to health and health-related services. A growing evidence base has established that CHWs can improve health care engagement and clinical outcomes.
NCDHHS through NC Medicaid has developed a proposed strategy for leveraging the growing number of CHWs in North Carolina to achieve the goals of Medicaid managed care. NC Medicaid’s strategy for incorporating CHWs into managed care in the future includes:
- Deploying CHWs to reach specific communities and target populations—namely, Medicaid members not engaged in health care or members underutilizing Medicaid services, as well as maternal and pediatric members;
- Supporting efforts to ensure CHWs are local to the communities they serve;
- Providing health plans with flexibility to use CHW services to improve health outcomes for select target populations;
- Testing a model that considers employment and contracting of CHWs at a ratio of CHWs to health plan members;
- Requiring minimum training and development for CHWs who support NC Medicaid members; and
- Developing bi-directional feedback and monitoring processes, including requiring health plans to submit a CHW and Member Engagement Plan to the Department for approval.
NCDHHS encourages health plans, providers, CBOs and other entities exploring or already leveraging CHWs to implement components of this proposed strategy now in pursuit of the advancement of community-centered, equitable care for Medicaid members. Certain components of the strategy are already supported through existing funding, whereas other components are contingent upon additional funding appropriations.
NC Medicaid’s CHW Strategy Guidance for Public Comment
NCDHHS has published North Carolina Medicaid’s CHW Strategy Guidance Paper to seek feedback on the vision and approach of this strategy developed to further drive the integration of CHWs into NC Medicaid’s managed care system. NC Medicaid welcomes feedback and input on all components of this strategy by emailing Medicaid.NCEngagement@dhhs.nc.gov (subject line “CHW Feedback”) by March 15, 2023.