Since March 2022, NC Medicaid has set a national precedent by reimbursing for evidence-based, non-medical services to address whole-person health through its Healthy Opportunities Pilot (NC HOP). NC HOP is a groundbreaking program that connects eligible beneficiaries to care management and provides reimbursement for the provision of non-medical services that address beneficiaries’ health-related social needs related to food, housing, transportation, and interpersonal violence or toxic stress.
The 28 NC HOP services are defined and priced in the Department’s Pilot Service Fee Schedule and are available to NC Medicaid beneficiaries who live in a Pilot region and have at least one qualifying physical or behavioral health condition and one qualifying social risk factor.
Across 33 counties, over 288,000 services have been delivered and more than 20,000 NC Medicaid members have enrolled, as of February 29, 2024. For stories about how Healthy Opportunities Pilots are positively impacting people in our communities, news and key metrics of the pilots, please see the Healthy Opportunities Pilots at Work webpage.
How Providers can Refer Medicaid Members
Providers play an essential role in helping to identify Medicaid members that can benefit from NC HOP services—including identifying physical or behavioral health conditions or non-medical needs that may qualify someone for the Pilots.
A provider may connect a member to their health plan by calling the health plan’s Member Services Line (listed below) and making a warm handoff or by using NCCARE360’s “Benefits Eligibility Screening” referral to indicate that a member is interested in, and may be eligible for, Healthy Opportunities Pilot services. The member’s health plan will assess if the member is eligible for NC HOP services and connect the member to services that meet their needs.
In addition to being identified by a provider, Medicaid members may be identified as potentially being eligible for NC HOP services by one of many other pathways: by their health plan or care manager, referral from a community-based organization (referred to as a Human Service Organization or HSO), or by self/family referral. Any of these individuals or organizations can call the member’s health plan to see if the member is eligible.
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
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