For the first time, North Carolina Medicaid is addressing whole-person health by covering non-medical services addressing beneficiaries needs related to food, housing, transportation and toxic stress. It is estimated that up to 80 percent of a person’s health is affected by concerns outside of traditional health care, and the Healthy Opportunities Pilot program intends to address some of those key social and environmental drivers of health. These Healthy Opportunities Pilot services are now available to qualifying NC Medicaid Managed Care Standard Plan beneficiaries in 33 counties in North Carolina.
The Healthy Opportunities Pilots cover the cost of 29 interventions defined and priced in the Department’s Pilot Service Fee Schedule. To be eligible for and receive Pilot services, NC Medicaid Managed Care beneficiaries must live in a Pilot region (in one of the counties listed below) and have at least one qualifying physical or behavioral health condition and one qualifying social risk factor, as defined by the Department.
The Healthy Opportunities Pilots are part of the Department’s focus on four priority domains: food, housing, transportation and interpersonal safety/toxic stress (with Cross-Domain indicating more than one service).
Examples of services provided through the Healthy Opportunities Pilots
Housing
- Inspection for Housing Safety and Quality to ensure living environment is not adversely affecting occupants’ health and safety
- Essential utility setup
- Accessibility and safety modifications
Food
- Food and Nutrition Access Case Management Services to provide one-on-one case management and/or education services and connect a member to appropriate and accessible community resources
- Healthy food boxes (home delivered or pick-up)
- Diabetes Prevention Program
Transportation
- Reimbursement for health-related private transportation that may help connect a member to Pilot services or other resources, especially when NEMT may not be the appropriate support
- Reimbursement for health-related public transportation
- Transportation for case management services
Toxic Stress
- Evidence-based parenting curriculum for families who are at risk of disruption due to parental stress or difficulty coping with parenting challenges, or child behavioral or health issues
- Home visiting services
Cross-Domain
Medical respite for members experiencing housing insecurity to access medical care and other supportive services, like prepared meals, transportation to medical appointments, and a private bed to promote recovery, upon hospital discharge
Additional services related to Interpersonal Violence (IPV)/Toxic Stress and Cross Domain services will be rolled out at a later date.
Pilot Regions
- Access East, Inc. - counties: Beaufort, Bertie, Chowan, Edgecombe, Halifax, Hertford, Martin, Northampton, Pitt.
- Community Care of the Lower Cape Fear - counties: Bladen, Brunswick, Columbus, New Hanover, Onslow, Pender.
- Impact Health - counties: Avery, Buncombe, Burke, Cherokee, Clay, Graham, Haywood, Henderson, Jackson, Macon, Madison, McDowell, Mitchell, Polk, Rutherford, Swain, Transylvania, Yancey.
How to Refer Patients to the Pilot Program
Providers can refer patients to Healthy Opportunities Pilot services by having patients call the Member Services line on their health plan Member ID card (see Health Plans’ Member Services numbers below). For more information, please visit the Healthy Opportunities Pilots webpage or the Healthy Opportunities Frequently Asked Questions.
Contact
For more information, call the NC Medicaid Contact Center: 888-245-0179
Provider Health Plans’ Member Services Numbers:
AmeriHealth Caritas: 855-375-8811 (TTY 1-866-209-6421)
Carolina Complete Health: 833-552-3876
Healthy Blue: 844-594-5070 (TTY 711)
United Healthcare: 800-349-1855
WellCare: 866-799-5318