Healthy Opportunities

Healthy Opportunities Pilot (HOP) services are now available to eligible NC Medicaid Direct members, and will be available to eligible Tailored Plan members beginning July 1, 2024.

HOP focuses on connecting members to resources that address important needs — beyond health care. Having access to medical care is important, but there are other factors that affect how we get and stay healthy. When we don’t have the things we need, it can hurt our bodies, leading to things like higher levels of stress, high blood pressure, and a weaker immune system.

Woman chopping vegetable's in the kitchen.

That’s where HOP comes in. Through this pilot program, Vaya uses Medicaid to reimburse community organizations that can help:

  • Improve housing and living conditions.
  • Make sure you have enough food.
  • Find transportation to non-emergency medical appointments so you can get to work, school, and community events.
  • Manage interpersonal violence and toxic stress at home and in your community.

The NC Department of Health and Human Services (NCDHHS) launched HOP in 33 counties across North Carolina.

HOP Member Rights and Responsibilities

FAQs

The Healthy Opportunities Pilot, or HOP, is NCDHHS’ approach to address how social determinants of health impact our health. Social determinants of health are conditions in the places where people live, learn, work, and play that affect a wide range of health risks and outcomes.

Research shows that social determinants of health determine up to 80% of a person’s health.

With this in mind, the Centers for Medicare & Medicaid Services (CMS) gave $650 million in funding to allow NCDHHS to create HOP. NCDHHS is partnering with human services nonprofits and health agencies to connect NC Medicaid beneficiaries with resources that can help benefit a person’s health. Right now, the program focuses on four areas:

  • Housing stability
  • Food security
  • Transportation
  • Interpersonal violence and toxic stress

NCDHHS selected three organizations to serve as network leads in each of the regions where HOP is available. Impact Health is the lead for the 18 westernmost counties, which include the 16 HOP counties that Vaya serves. A directory of the full Western North Carolina HOP network is on the Impact Health website.

As a pilot program, HOP is only available in certain counties for a limited time. This tests whether the program can help improve people’s wellbeing and reduce health care costs. If it is successful, the program likely will expand across the state.

HOP will cover the cost of a variety of services. These services help with housing, food, transportation, and interpersonal violence/toxic stress.  Below are a few examples of the types of services.

Housing

  • One-time security deposit and first month’s rent
  • Inspection for housing safety and quality
  • Home remediation services
  • Home accessibility and safety modifications
  • Short-term post-hospitalization housing
  • Linkages to legal support services

Food

  • Healthy food box (delivery and/or pick-up)
  • Fruit and vegetable prescription
  • Medically tailored, home-delivered meals
  • Group nutrition classes
  • Diabetes prevention program

Transportation

  • Transportation to support health needs like the grocery store or fitness center
  • Taxi and ride-sharing credits where public transportation is unavailable
  • Reimbursement for gas mileage
  • Vehicle repairs
  • Evidence-based parenting curriculum
  • Home visiting services

A care manager or health plan can provide the full list of services. Health plans and care managers will determine which services to provide to each member. Nonprofit human services organizations will deliver services in a member’s region, where available.

To be eligible, you must: 

  • Have at least one qualifying physical or behavioral health condition, which vary by population. For example:
    • An intellectual and/or developmental disability (I/DD), Traumatic Brain Injury (TBI) for all age groups
    • Criteria is met to receive Tailored Care Management (TCM) services for all age groups
    • Two or more chronic conditions for adults
    • Multifetal gestation for pregnant people
    • Neonatal intensive care for children ages 0-3
    • Three or more adverse childhood experiences for children ages 0-20
    • Children ages 0-20 with one or more chronic conditions, or who have been diagnosed with cancer and/or an autoimmune disease.
  • Have one State-defined qualifying social risk factor, which include:
    • Being homeless or housing insecure
    • Lacking food security
    • Lacking transportation
    • Being at risk of witnessing or experiencing interpersonal violence

HOP is available in three areas of North Carolina, each of which have a separate network lead, as shown on the map below.

Health opportunities coverage map

Vaya serves 16 counties where HOP is available. Those counties are Avery, Buncombe, Cherokee, Clay, Graham, Haywood, Henderson, Jackson, Macon, Madison, McDowell, Mitchell, Polk, Transylvania, Swain, and Yancey.

There are many other resources available to meet your non-medical needs:

  • Talk to your care manager about NCCARE360 and other available options.
  • Call the Vaya Member and Recipient Service Line at 1-800-962-9003, Monday-Saturday, 7 a.m.-6 p.m.
  • Call 211 to talk to someone who can help find local resources and services in your community.

Healthy Opportunities start here

For more information about eligibility and how to access these services, talk to your care manager or call the Vaya Member and Recipient Service Line at 1-800-962-9003Monday through Saturday 7 a m to 6 p m