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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 a Medicaid Managed Care model, which began on July 1. This transformation essentially outsources the management and reimbursements of the state’s Medicaid system to private health plans.
HOP will allow nonprofit human services organizations (HSOs) to receive Medicaid reimbursements from the private health plans for the services they provide to qualifying Medicaid members related to housing, transportation, food, or interpersonal safety.
NCDHHS is supporting Healthy Opportunities Pilots in three areas across the state, and named Dogwood Health Trust as the Network Lead for the 18 counties in Western North Carolina. To manage this work, Dogwood created Impact Health as a new community led nonprofit entity.
Area nonprofits and community partners applied to participate in the Healthy Opportunities Pilot and become part of the HSO Network. This network will deliver services to high-risk Medicaid beneficiaries approved to participate in the pilot.
NCDHHS has recently adjusted to a phased approach by domain.
This adjustment will not change capacity-building funds being distributed or the process for enrolling HSOs into NCTracks, NCCARE360, exclusion monitoring, etc. This phased rollout allows Impact Health an ideal opportunity to shift how we support HSOs with training, budget development and technical assistance. We are currently working with NCDHHS to review the new timelines and align the training schedules to meet HSO needs and the needs of the Pilot.