North Carolina wellness program experiences growing pains

The North Carolina Medicaid office launched the first-of-its-kind program in March to encourage people to pursue a healthy lifestyle rather than only paying for care when an individual is sick. However, an Aug. 24 report in North Carolina Health News indicates that growing pains come with the new territory.

The most significant problem for the initiative called the Healthy Opportunities Pilot is the referral process, according to multiple human services organizations listed in the report. 

Insurance company case managers act as the program gatekeepers and identify individuals who are "high cost" or regularly using expensive services like the emergency room. The case manager communicates with the individual to determine if they have chronic health conditions or unmet social needs. If they answer yes to both questions, they are eligible for services provided under the Healthy Opportunities Pilot, and the case manager refers them to community nonprofit services in their area. 

Amy Upham, the executive director of Eleanor Health Foundation in Buncombe County, said that the organization received 100 applications from qualified applicants for service each month but only a few referrals from the program. 

"We could potentially be serving 30, 40, maybe even 50 people a month who are on Medicaid, and we’re getting three referrals a week," Ms. Upham said. 

Leigh Waters, the client services coordinator at the Community Housing Coalition of Madison County, says they have received only a few referral attempts but have not administered any services or received any Healthy Opportunities Pilot funds. 

"I definitely see the need, and I also see on the other hand these funds that HOP does have, and so it's frustrating to know there's money there that's not being spent," she said. 

Ms. Waters also said that they typically tell clients that they may be a fit for the Healthy Opportunities Pilot and encourage them to seek referrals. 

All services through the Healthy Opportunities Pilot program require patients to be pre-approved for eligibility.

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