Healthy Opportunities

Healthy Opportunities Pilot (HOP) services are now available to eligible NC Medicaid Direct and Tailored Plan members.

The Healthy Opportunities Pilot (HOP) program focuses on connecting people 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 pay community organizations for services and supports that can help:

  • Improve housing and living conditions
  • Make sure you have enough food
  • Access transportation for things that impact your wellbeing like 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. This includes 16 counties that Vaya serves.

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

HOP Member Rights and Responsibilities

FAQs

NCDHHS is using the Healthy Opportunities Pilot, or HOP to find out how much addressing social determinants of health can improve health outcomes and reduce health care costs. 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 can influence up to 80% of a person’s health.

 

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. North Carolina hopes to expand this program statewide in 2025.

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

  • 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

 

Your care manager can provide the full list of services, or you can call the Vaya Member and Recipient Service Line at 1-800-962-9003 (Monday – Saturday, 7 a.m. to 6 p.m.). Vaya will help connect members to the HOP services that are right for them.

To be eligible, you must:

  • Have at least one qualifying physical or behavioral health condition. For example:
    • An intellectual and/or developmental disability (I/DD), Traumatic Brain Injury (TBI) for all age groups
    • Meet criteria 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 currently 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

Need Help?

Finding care can be confusing sometimes. At Vaya Health, we make it easier. The process starts with a phone call to our Member and Recipient Services Line at
1-800-962-9003