Healthy Opportunities Pilot Program overview
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Describes Carolina Complete Health's participation in North Carolina's Healthy Opportunities Pilot Program, the covered non-medical interventions, eligibility criteria, regional operation, participating entities, and evaluation approach for eligible Medicaid members in specified pilot counties.
No material clinical or coverage changes in this revision.
Healthy Opportunities — Coverage Criteria
Coverage criteria for Healthy Opportunities Pilot
Covered when ALL of the following are met:
ALL of the following
Eligibility
- Member is enrolled in Carolina Complete Health
- Member lives in one of the Region 5 Pilot counties (Bladen, Brunswick, Columbus, New Hanover, Pender)
- Member has at least one qualifying physical or behavioral health risk as defined by NCDHHS
- Member has at least one qualifying social risk factor as defined by NCDHHS
Services covered (limited to predefined interventions)
- Housing and Move-In Support
- Home Safety and Remediation Services
- Utility Assistance
- Food & Nutrition Assistance
- Post-Hospitalization Housing
- Non-Medical Transportation Support
Service scope and limits
- Services are limited to the 29 predefined interventions defined and priced in the Department's Pilot Service Fee Schedule
- Interventions fall into five categories: Food; Housing; Transportation; Interpersonal safety; Toxic stress
Service Codes and Fee Schedule
| 29 interventions defined and priced in the Department's Pilot Service Fee Schedule (codes/pricing referenced but not listed here). |
Care Manager Eligibility Determination & Provider Roles
Care Manager determines Healthy Opportunities eligibility
A Carolina Complete Health Care Manager will evaluate individual member needs to determine eligibility for the Healthy Opportunities pilot. To qualify, members must be enrolled in Carolina Complete Health, live in one of the Region 5 Pilot counties (Bladen, Brunswick, Columbus, New Hanover, Pender), and have at least one qualifying physical/behavioral health risk and at least one qualifying social risk factor as defined by NCDHHS.
- Member is enrolled in Carolina Complete Health
- Member lives in one of the Region 5 Pilot counties: Bladen, Brunswick, Columbus, New Hanover, Pender
- Member has at least one qualifying physical/behavioral health risk as defined by NCDHHS
- Member has at least one qualifying social risk factor as defined by NCDHHS
Key Terms and Entities
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