Budget proposals from both chambers of the North Carolina General Assembly do not include funding for Healthy Opportunities Pilots (HOP) services beyond June 30, 2025, for the State Fiscal Years 2026 - 2027.
In alignment with contractual obligations to health plans and in an effort to remain fiscally responsible with available resources, the Department is preparing to stop HOP services beginning July 1, 2025.
The Department recognizes the significant impact this change may have on the individuals and communities it serves, and it is continuing conversations with State lawmakers about the importance of HOP and value in continued funding. While new services should stop beginning July 1, the Department hopes this will only be a pause, and HOP can resume once additional funds are appropriated by the General Assembly.
The Department will continue to monitor the budget negotiation process. Health plans are expected to notify their contracted HOP participating Care Managers, all Human Service Organizations (HSOs) and Network Lead(s) of the stop to service deliveries effective on a date no earlier than July 1, 2025, as selected by the health plan.
Health plans may begin to stop new service authorizations as of June 2, 2025. As they stop services, health plans must:
- Update their websites by July 1, 2025, that HOP Services are stopped for new authorizations and the effective date on which new authorizations are being stopped; and
- Notify Members and HSOs of any suspension, termination, or other modification being made to an existing authorization no later than 10 days prior to the effective date of the modification (ex. Members must be notified by June 20, 2025, of changes going into effect July 1, 2025).
- Note: Members receiving IPV-services must only be notified by their required method of communication.
Additional expectations:
- Network Leads are expected to continue to monitor and oversee their network of HSOs, manage the HSO infrastructure, and support program communications during this time.
- HOP-participating Care Management Entities are expected to continue HOP-related care management activities through the termination or suspension of a Member’s HOP services.
- HSOs are expected to continue providing authorized HOP services, until such a time as they are notified of the termination or suspension of a Member’s HOP services.
The Department will notify partners of any adjustments to the HOP service delivery funds allocated for SFY 26.