Health Determinants, Sustainable Health Equity, and Sustainable Development Goal 3.8: Policy Threats and Community-Based Solutions in North Carolina, USA
1
Founder, The Lemonade Center, Charlotte, United States
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
ABSTRACT:
Abstract Health equity in the United States remains fragile, with structural barriers limiting access to essential care despite ongoing reforms. In North Carolina, disparities are deepening following October 2025 Medicaid reimbursement cuts that reduce rates for behavioral health, therapy, and community-based services. These changes threaten access for children and families affected by autism spectrum disorder (ASD), developmental delays, and behavioral health challenges—undermining progress toward Sustainable Development Goal (SDG) 3.8, which calls for universal health coverage, financial risk protection, and affordable, quality care.
OBJECTIVES:
This case study explores (1) how Medicaid rate reductions exacerbate inequities in autism and behavioral health access, (2) the potential of grassroots models—such as the forthcoming Lemonade Center in Charlotte, NC (opening Spring 2026)—to close service gaps and expand rural access, and (3) lessons for sustainable funding and system reforms aligned with SDG 3.8.
METHODS:
A qualitative policy and narrative case study approach drew on state Medicaid announcements, literature on social determinants and SDGs, and planning documents for The Lemonade Center. Anticipated service components—autism therapy, integrated behavioral health, onsite pharmacy, and rural outreach—were assessed against health-equity frameworks and SDG 3.8 indicators to identify gaps between state policy and community innovation.
RESULTS:
Preliminary analysis indicates that reimbursement cuts disproportionately affect vulnerable families with limited service options. The Lemonade Center model projects: (a) expanded autism and behavioral-health access in underserved regions, (b) integrated therapy-medical-pharmacy coordination, (c) scholarship and subsidy mechanisms to reduce financial strain, and (d) scalable frameworks for rural extension.
CONCLUSIONS:
North Carolina’s Medicaid cuts illustrate how policy decisions can widen inequities and slow SDG progress. Yet grassroots solutions like The Lemonade Center demonstrate how community-led innovation can advance equity, sustainability, and universal-coverage goals through integrated, interdisciplinary, and socially responsive design.
Abstract Health equity in the United States remains fragile, with structural barriers limiting access to essential care despite ongoing reforms. In North Carolina, disparities are deepening following October 2025 Medicaid reimbursement cuts that reduce rates for behavioral health, therapy, and community-based services. These changes threaten access for children and families affected by autism spectrum disorder (ASD), developmental delays, and behavioral health challenges—undermining progress toward Sustainable Development Goal (SDG) 3.8, which calls for universal health coverage, financial risk protection, and affordable, quality care.
OBJECTIVES:
This case study explores (1) how Medicaid rate reductions exacerbate inequities in autism and behavioral health access, (2) the potential of grassroots models—such as the forthcoming Lemonade Center in Charlotte, NC (opening Spring 2026)—to close service gaps and expand rural access, and (3) lessons for sustainable funding and system reforms aligned with SDG 3.8.
METHODS:
A qualitative policy and narrative case study approach drew on state Medicaid announcements, literature on social determinants and SDGs, and planning documents for The Lemonade Center. Anticipated service components—autism therapy, integrated behavioral health, onsite pharmacy, and rural outreach—were assessed against health-equity frameworks and SDG 3.8 indicators to identify gaps between state policy and community innovation.
RESULTS:
Preliminary analysis indicates that reimbursement cuts disproportionately affect vulnerable families with limited service options. The Lemonade Center model projects: (a) expanded autism and behavioral-health access in underserved regions, (b) integrated therapy-medical-pharmacy coordination, (c) scholarship and subsidy mechanisms to reduce financial strain, and (d) scalable frameworks for rural extension.
CONCLUSIONS:
North Carolina’s Medicaid cuts illustrate how policy decisions can widen inequities and slow SDG progress. Yet grassroots solutions like The Lemonade Center demonstrate how community-led innovation can advance equity, sustainability, and universal-coverage goals through integrated, interdisciplinary, and socially responsive design.
| eISSN: | 2654-1459 |
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