Advancing Community-Based Models of Health and Social Care in North Carolina (2025-2026)

Background

Unmet health-related social needs – such as food insecurity, housing instability, transportation issues, and interpersonal violence and stress – significantly impact health and well-being. Many North Carolinians face health-related social needs and feel their impacts every day. Currently, North Carolina (NC) Medicaid (a health insurance program for qualifying low-income residents) is at the forefront of addressing these needs through innovative policies, programs and services such as the Healthy Opportunities Pilots (HOP) and the Integrated Care for Kids (InCK).  

NC HOP pays community-based organizations to deliver 29 services to address health-related social needs. This program is currently being implemented in three predominantly rural regions of North Carolina, and recently received approval to expand statewide.

NC InCK partners with communities to support and bridge services across the health, social and education sectors to advance the health and well-being of children and their families. It is currently being implemented in five counties in the Triangle region.

The success of these programs relies on building and sustaining the capacities of community-based organizations (CBOs), which have decades of experience in understanding and addressing local community needs. Many of these organizations vary in organizational traits that affect the readiness, success and challenges working across sectors. Many also operate in an economic landscape in which financial instability is common. As these initiatives grow, state policymakers need further guidance on how to scale and sustain CBOs and partnerships to advance whole person health in the state.

Project Description

This project team will investigate the organizational traits of CBOs engaged in the N.C. Healthy Opportunities Pilots and the Integrated Care for Kids program to inform recommendations to support, sustain and scale their capacity to meet health-related social needs in the state.

Team members will conduct a landscape analysis to identify the major characteristics of approximately 150-200 CBOs, including exploring their organizational structures, service types and offerings, geographic scopes, populations served, financial models and other characteristics. Team members will organize this information to create “CBO archetypes” or categories of CBOs based on their organizational traits, allowing them to describe how these factors impact their capacity, readiness, effectiveness and path towards sustainable success.

Team members will also conduct a literature review focusing on previous research describing how CBOs work with healthcare programs in other states. They will explore what helps or hinders CBOs’ success and long-term stability when partnering with healthcare. The team’s research findings will be compiled into a landscape and policy paper that will help guide recommendations for programs like HOP, InCK and others. The paper will provide policy and operational recommendations for supportive pathways to enable the capacity building, sustainability and success of CBOs across archetypes.

Anticipated Outputs

Dataset on CBOs archetypes; landscape and policy paper; presentations for key stakeholders

Student Opportunities

Ideally, this project will include 1 graduate student and 4 undergraduate students interested in health policy, public policy, sociology, economics, business, population health sciences and/or medicine/health professions. Prospective applicants should also hold interests in social determinants of health, health equity, child and family health, the integration of health and social care, and/or community-driven models to address health challenges.

Team members will have the opportunity to learn and apply skills in team-based research and writing. Students will learn about the landscape of CBOs across North Carolina and health policy initiatives to address health-related social issues. They will conduct literature reviews, synthesize results, participate in collaborative writing and present their research to diverse audiences. Students will also have opportunities to build soft skills in teamwork, communication and time management.

In Fall 2025, the team will meet on Thursdays from 1:25-2:55 p.m.

A graduate student will be selected to serve as project manager. The graduate/professional student involved in the project will have opportunities to gain practical skills and experience in project management, advanced research skills, leadership and mentorship. This student would also have the option to work on the project full-time during Summer 2025.

Timing

Summer 2025 – Summer 2026  

• Summer 2025 (optional): Graduate student will help plan for the project year
• Fall 2025: Conduct research on community-based organizations for landscape analysis/analytic product; conduct literature review; identify community-based organization archetypes
• Spring 2026: Translate findings into policy/operational recommendations; draft and publish landscape and policy paper; present findings
• Summer 2026 (optional): Continue to present and disseminate research

Crediting

Academic credit available for fall and spring semesters; summer funding available

 

_{Image: NC Integrated Care for Kids (InCK) header graphic on NC Medicaid website}