Innovations in Healthcare: Lessons from North Carolina’s Medicaid Demonstration for New York State

A few years ago North Carolina expanded its 1115 Medicaid waiver and has served as a reference point for the pending New York State 1115 waiver. Navigating the complex landscape of healthcare requires leveraging several data points and these insights can pave the way for a more effective and patient-centered approach to the New York 1115 waiver.

Lesson 1: Tailoring Medicaid to Meet Local Needs

One of the key takeaways from North Carolina’s demonstration is the importance of tailoring Medicaid programs to the unique needs of the local population. There are unique challenges between rural and urban populations. New York can learn to customize its Medicaid policies, ensuring that they align with the diverse healthcare requirements of its residents. This approach fosters a more responsive and inclusive healthcare system.

Lesson 2: Building Strong Community Partnerships

North Carolina’s success is partly attributed to its emphasis on building strong partnerships with local communities. This was primarily through setting up local human service networks called Network Leads (formerly Local Pilot Entities or LPE).  The  New York 1115 waiver sets up Social Care Networks (SCN) to foster collaborations between healthcare providers, community organizations, and government agencies. These partnerships can lead to improved coordination of care, better health outcomes, and increased community engagement.

Lesson 3: Embracing Value-Based Care Models

The shift towards value-based care is a game-changer in healthcare delivery. New York can draw inspiration from North Carolina’s successful integration of value-based care models within its Medicaid program. By focusing on outcomes rather than volume, healthcare providers can prioritize preventive care, reduce costs, and enhance the overall quality of healthcare services.

Lesson 4: Engaging in Continuous Evaluation and Improvement

North Carolina’s Medicaid Demonstration involved continuous evaluation and refinement of its strategies. New York can adopt a similar approach, regularly assessing the impact of its Medicaid policies and making necessary adjustments. This commitment to ongoing improvement ensures that the state’s healthcare system remains adaptable and effective in addressing evolving healthcare challenges.

Lesson 5: Prioritizing Social Determinants of Health

Understanding and addressing social determinants of health is crucial for comprehensive healthcare reform. North Carolina’s initiative highlights the significance of recognizing and mitigating factors such as housing, education, and economic stability. New York can incorporate similar strategies to create a more holistic and patient-focused Medicaid program.


As New York State embarks on its own journey of healthcare transformation through the 1115 waiver, the lessons learned from North Carolina’s Medicaid Demonstration serve as a valuable guide. By tailoring policies, building partnerships, embracing value-based care, engaging in continuous improvement, and prioritizing social determinants of health, New York has the opportunity to shape a healthcare system that truly meets the needs of its diverse population. Through thoughtful implementation and a commitment to innovation, the Empire State can pave the way for a healthier and more equitable future.