NC Medicaid is addressing whole-person health through its Healthy Opportunities Pilots, a groundbreaking program that covers non-medical services that address beneficiaries’ needs related to food, housing, transportation, and interpersonal violence/toxic stress. The 29 Pilot services are defined and priced in the Department’s Pilot Service Fee Schedule and are available to NC Medicaid Managed Care beneficiaries who live in a Pilot region and have at least one qualifying physical or behavioral health condition and one qualifying social risk factor. The services are anticipated to be available to Tailored Plan members in the second quarter of 2023.
As of Jan. 4, 2023, nearly 24,000 Pilot services have been delivered to nearly 3,000 enrollees, predominantly within the food domain. With housing and transportation services picking up, the number of Medicaid members receiving Pilot services continues to rise quickly and is up over 90 percent since September 2022. For stories about how Healthy Opportunities Pilots are positively impacting people in our communities and key metrics of the pilots, please see the Healthy Opportunities Pilots at Work webpage.
For more information about services provided and Pilot regions, please see NC Medicaid Bulletin REMINDER: Healthy Opportunities Services Available.
How Providers can refer Medicaid Members
Providers play an essential role in helping to identify Medicaid members that can benefit from Pilot services—including identifying physical or behavioral health conditions that may qualify someone for the Pilots. A provider may contact a members PHP to request the member be assessed for Pilot services. For members without a care manager, providers can help 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.
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
NC Medicaid Contact Center: 888-245-0179