Healthy Opportunities Pilot launches for Medicaid Direct Populations

Expanding Pilot Eligibility to Members in NC Medicaid Direct in Pilot Regions

On May 15, 2024, the Healthy Opportunities Pilot (HOP) program will expand eligibility to include a subset of members living in Pilot regions who are enrolled in NC Medicaid Direct. Members who are eligible to receive tailored care management and receive services from an LME/MCO, may now also qualify for HOP services. This expansion is provided through an amendment to North Carolina Medicaid’s section 1115 demonstration waiver. This expansion will address the non-medical needs of approximately 14,000 additional members.  

Until this amendment approval, only individuals who met HOP eligibility criteria and received Medicaid through one of the five Standard Plans have been eligible to participate in the Pilots. The waiver amendment expands HOP eligibility to include NC Medicaid Direct populations enrolled in Tailored Care Management in Pilot regions in addition to those who receive Medicaid coverage through NC Medicaid Managed Care. It is likely that eligibility criteria for the NC Medicaid Direct Tailored Care Management population will have a great amount of overlap with HOP eligibility criteria because of this population’s behavioral health needs. 

The federal government has authorized up to $650 million in Medicaid funding for HOP over five years, with the services addressing issues related to food insecurity, housing insecurity, transportation insecurity, and interpersonal safety and toxic stress.  The HOP program is the nation’s first comprehensive program to test and evaluate the impact of providing select evidence-based, non-medical interventions. Members who qualify would be referred for one of the Pilot’s 28 CMS-approved services, including healthy food boxes; assistance with utility payments; rent assistance; home remediation; transportation for non-medical reasons, like to community events, school, or work; and violence intervention services to address community safety.  

The Department is also seeking authority from CMS to extend the waiver period for an additional 5-years, expand the Pilots statewide, modify service offerings, and further modify HOP eligibility criteria. More details on N C’s 1115 waiver renewal application can be accessed here

To learn more about the Healthy Opportunities Pilots, please visit the Healthy Opportunities Pilots webpage or the Healthy Opportunities Frequently Asked Questions


NC Medicaid Contact Center, 888-245-0179 

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