How North Carolina is Improving Lives Through the Healthy Opportunities Pilot

The Healthy Opportunities Pilot (HOP) is the nation’s first comprehensive program to provide evidence-based interventions—including housing, food, transportation, interpersonal safety, and toxic stress support services—to high-needs Medicaid enrollees. Through an 1115 waiver, the federal government has authorized up to $650 million in Medicaid funding to reimburse providers in North Carolina for these non-medical interventions over five years. This program will ensure that Medicaid members have timely access to critical social care services to improve their health. 

Unite Us is proud to serve as the technology backbone connecting health plans, network leads, providers, and public entities engaged in HOP. With Unite Us’ Social Care Payments product, providers can manage eligibility and authorization, send referrals to contracted providers, securely track outcomes and document services, generate invoices, and efficiently manage reimbursement of social care services.

In record time, Unite Us successfully socialized the new program and trained, onboarded, and enabled five prepaid health plans, three network leads, three clinically-integrated networks, and more than 100 health service organizations.

HOP is Expanding Social Care to North Carolinians

In the first few months since HOP launched in March 2022, community-based organizations have provided nearly 10,000 social care services that are—for the first time in the nation—eligible for Medicaid reimbursement. In that same time, North Carolinians have received more than 5,000 food boxes addressing needs like food insecurity and many others. 

To date, 97 percent of individuals identified by a care manager as eligible for the pilot were successfully enrolled in the program. After a service is approved through the CMS-mandated workflow, providers accept the referral to provide services within one day on average. And the rejection rate for claims is less than 3%, compared to typical clinical rejection rates of 10-20%, which reflects the high-quality eligibility and invoicing process facilitated by Unite Us and its partners in North Carolina.

Unite Us has a long history of proven success in North Carolina dating back to 2015. Following the success of the competitively procured, statewide care coordination network in North Carolina powered by Unite Us—known as NCCARE360—the state made the decision to work with Unite Us to launch the Healthy Opportunities Pilot in 2022 to reduce silos, improve efficiency, and reduce overall spend. 

Unite Us is extremely proud of our work supporting communities across North Carolina, the success of which has been recognized throughout the country, including by the North Carolina Institute of Medicine; Health Leaders; the Center for American Progress; Princeton School of Public and International Affairs; and Politico.

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