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NCDHHS Transitions Leadership to New Secretary, Dr. Dev Sangvai
On January 12, 2025, Dr. Devdutta “Dev” Sangvai was sworn in as North Carolina Secretary for Health and Human Services, following former Secretary Kody Kinsley’s tenure at the Department. Kinsley reflected on the Department’s accomplishments over his past three years as Secretary, including historic milestones such as enrolling over 600,000 North Carolinians in Medicaid Expansion, $835 million invested into behavioral health care improvements, and changes rooted in the goal of making the health system easier to navigate for families and more effective at promoting health. In his swearing-in ceremony, Dr. Sangvai remarked at how he is looking forward to building on the strong foundation built during Secretary Kinsley’s tenure and continue working toward creating a healthier North Carolina. Prior to Dr. Sangvai’s nomination, he served as President of Duke Regional Hospital, Vice President for Duke Population Health Management for Duke University Health System, and President of the North Carolina Medical Society. Dr. Sangvai is a family medicine physician and a professor at Duke University, as well as a member of the North Carolina Medical Board. Read his NCDHHS bio here. The NC STC looks forward to continuing to work with Dr. Sangvai in his new role to advance health care transformation in the state.
CMS Approves NC’s 1115 Demonstration Waiver Renewal
On December 18, 2024, the Centers for Medicare & Medicaid Services (CMS) sent an approval letter for North Carolina’s renewal of its 1115 Demonstration Waiver, with the opportunity to expand the NC Healthy Opportunities Pilot (HOP) statewide for an additional five-year demonstration period. The pilot program was originally approved by CMS in 2018 to provide 29 evidence-based services to address social needs through community-based health services organizations to eligible Medicaid enrollees in three regions of the state. In addition to the statewide expansion of HOP and extending ongoing managed care authorities, the waiver includes four new initiatives on: streamlining Medicaid enrollment for children and youth; improving care for justice-involved populations; investing in technologies to serve behavioral health and intellectual/developmental disabilities; and bolstering supports for the behavioral health and long-term services and supports workforce. The Stein administration and General Assembly are considering plans for NC HOP expansion, as part of current discussions around the Governor’s Budget Recommendations.
The Interim Evaluation Report on the NC Healthy Opportunities Pilot found that NC HOP participants reported fewer health-related social needs and had significantly lower emergency department utilization than comparable individuals in non-HOP regions. The evaluation also found that costs per HOP beneficiary were $85 lower than expected without the program. The renewal of this waiver supports the NC STC’s goal of improving population health, as well as the Health Disparities Data Workgroup’s efforts to improve data practices to address identified health disparities across North Carolina. Additional information on the NC Section 1115 Demonstration Waiver and its renewal can be found here, as well as in Duke-Margolis published research on HOP and a recent webinar on the direct impacts of the program.
North Carolina Medicaid Releases Updated 2025 Medicaid Managed Care Quality Strategy
NC Medicaid released its Medicaid Managed Care Quality Strategy to provide updates on its aims, goals, and objectives for quality management and improvement, and details specific initiatives that are Department priorities throughout North Carolina’s transition into managed care. The 2024-25 strategy includes:
- Updated managed care implementation timeline and associated included, exempt, excluded and delayed populations;
- Updated language related to Tailored Plans and Child and Families Specialty Plans;
- Information related to the Medicaid expansion population; and
- Updated relevant quality measure sets.
In alignment with the NC STC’s overarching aim to achieve equitable and high-quality whole-person care, the Medicaid Managed Care Quality Strategy also outlines its focus on interventions that address health-related social needs, such as NC HOP as well as efforts to strengthen data sharing, such as supporting provider capacity to leverage the NC Health Information Exchange Authority (HIEA).
CMS Announces Model Portfolio Changes, Including Discontinuation of Making Care Primary Model
On March 12, 2025, the CMS Innovation Center (CMMI) announced that the Making Care Primary model would be ending early, by December 31, 2025. North Carolina was one of the eight states selected to participate in the model, which was slated to run through 2034. While this announcement means that the NC STC will no longer include a Making Care Primary Payers Workgroup, Duke-Margolis looks forward to continued collaboration as part of broader efforts on multi payer and multi-stakeholder alignment focused on reducing burden, improving efficiency and outcomes, and strengthening primary care.
NC Medicaid Advanced Medical Home Standardized Performance Incentive Program Policy Guide Released for Public Comment
North Carolina Medicaid has released a draft policy guide for its proposed Advanced Medical Home (AMH) Standardized Performance Incentive Program, which aims to establish a consistent framework for performance incentive payment arrangements between prepaid health plans (PHPs) and AMH providers. The proposed program was developed in response to provider feedback that variability in PHP performance incentive arrangements makes it challenging for AMH providers to participate in arrangements as well as align quality improvement efforts for Medicaid beneficiaries. The program was also initially developed as a feature of NC’s participation in the Making Care Primary Model. While the Making Care Primary model will not be continuing, NC Medicaid’s program remains an important step to advance broader goals of reducing provider burden and improving health outcomes. Additional details can be found in the draft AMH Standardized Performance Incentive Program Policy Guide, which is being shared for community partner input. Details on submitting feedback by the April 21st deadline are included in the draft guide.
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