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The Healthy Opportunities Pilot (HOP) is an innovative new approach to supporting the upstream social determinants of health and reducing the need for clinical interventions by using Medicaid dollars to pay for services related to transportation, nutrition, housing, and interpersonal safety. This Medicaid pilot program was developed by the North Carolina Department of Health and Human Services (NCDHHS) with a goal to ultimately improve health and save millions on treatment of clinical illnesses or conditions by investing in evidence-based interventions before health becomes a problem.
HOP is a part of North Carolina’s broader shift from state-managed Medicaid to Medicaid Managed Care, which began on July 1, 2021. This transformation essentially outsourced the management and reimbursements of the state’s Medicaid system to private health plans.
HOP allows nonprofit human service organizations (HSOs) to receive Medicaid reimbursements from private health plans for the services they provide to qualifying Medicaid members related to housing, transportation, food, and personal safety.
NCDHHS supports Healthy Opportunities Pilots in three areas across the state including the 18 counties in Western North Carolina. Impact Health is the organization charged with leading implementation of the pilot here in WNC and supports a network of 52 organizations providing food, housing, transporation and personal safety services.
The state is currently drafting an application to the Centers for Medicaid and Medicare which, if accepted, could extend the pilot for an additional five years and expand pilot services across the state.
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Stay up to date with the latest news and information from Impact Health.