Healthy Opportunities Pilot (HOP)
In 2022, IAM was selected to be part of the Healthy Opportunities Pilot, also known as HOP. This pilot program, based in North Carolina and the first of its kind in the nation, uses federal funding to provide non-medical interventions like healthy food, transportation, and housing assistance to high-needs Medicaid enrollees in our state.
Scroll down to see a lists of HOP services currently provided by IAM.
Learn more about this innovative program here..
HOP Services Offered by IAM
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Housing Services
Essential Utility Set-Up
Service Description
The Essential Utility Set Up service is a non-recurring payment to:
Provide non-refundable, utility set-up costs for utilities essential for habitable housing.
Resolve arrears related to unpaid utility bills and cover non-refundable utility set-up costs to restart the service if it has been discontinued in a Pilot enrollee’s home, putting the individual at risk of homelessness or otherwise adversely impacting their health (e.g., in cases when medication must be stored in a refrigerator).
This service may be used in association with essential home utilities that have been discontinued (e.g., initial payments to activate heating, electricity, water, and gas).
Minimum Eligibility Criteria
Enrollee must require service either when moving into a new residence or because essential home utilities will be imminently discontinued, have been discontinued, or were never activated at move-in and will adversely impact occupants’ health if not restored.
Enrollee demonstrates a reasonable plan, created in coordination with care manager or case manager, to cover future, ongoing payments for utilities.
This Pilot service is furnished only to the extent that the enrollee is unable to meet such expense or when the services cannot be obtained from other sources.
Services are authorized in accordance with PHP authorization policies, such as but not limited to service being indicated in the enrollee’s person-centered care plan.
This service is not covered as a Pilot service if the receiving individual would be eligible for substantially the same service as a Medicaid covered service.
Enrollee is not currently receiving duplicative support through other federal, state, or locally-funded programs.
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One-Time Payment for Security Deposit and First Month’s Rent
Service Description
Provision of a one-time payment for an enrollee’s security deposit and first month’s rent to secure affordable and safe housing that meets the enrollee’s needs. All units that enrollees move into through this Pilot service must:
Pass a Housing Quality Standards (HQS) inspection
Meet fair market rent and reasonableness check
Meet a debarment check
For homeless enrollees, all services provided must align with a Housing First approach to increase access to housing, maximize housing stability and prevent returns to homelessness.
Minimum Eligibility Criteria
Enrollee must be receiving Housing Navigation, Support and Sustaining Services or Holistic High-Intensity Enhanced Case Management.
Enrollees receiving services substantially similar to Housing Navigation, Supports and Sustaining Services through a different funding source (e.g. Medicaid State Plan, a 1915(c) waiver service, or a Housing and Urban Development grant) may still receive this Pilot service if deemed eligible.
The provider delivering a substantially similar service must coordinate with the enrollee’s Medicaid care manager (if applicable) to determine the necessity of the Pilot service and ensure appropriate documentation in the enrollee’s care plan.
Enrollee must receive assistance with developing a reasonable plan to address future ability to pay rent through a housing stability plan.
Housing unit must pass a Housing Quality Standards (HQS) inspection prior to move-in or, in certain circumstances, a habitability inspection performed by the case manager or other staff. If a habitability inspection is performed, an HQS inspection must be scheduled immediately following move-in.
Landlord must be willing to enter into a lease agreement that maintains a satisfactory dwelling for the enrollee throughout the duration of the lease, unless there are appropriate and fairgrounds for eviction.
This pilot service is provided only to the extent that the enrollee is unable to meet such expense or when the services cannot be obtained from other sources.
Services are authorized in accordance with PHP authorization policies, such as but not limited to service being indicated in the enrollee’s person-centered care plan.
Enrollee is not currently receiving duplicative support through other federal, state, or locally-funded programs.
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Food Services
Food and Nutrition Access Case Management Services
Provision of one-on-one case management and/or educational services to assist an enrollee in addressing food insecurity. Activities may include:
Assisting an individual in accessing school meals or summer lunch programs, including but not limited to:
— Helping to identify programs for which the individual is eligible
— Helping to fill out and track applications
— Working with child’s school guidance counselor or other staff to arrange servicesAssisting an individual in accessing other community-based food and nutrition resources, such as food pantries, farmers market voucher programs, cooking classes, Child and Adult Care Food programs, or other, including but not limited to:
— Helping to identify resources that are accessible and appropriate for the individual
— Accompanying individual to community sites to ensure resources are accessed
Advising enrollee on transportation-related barriers to accessing community food resources
It is the Department’s expectation that Medicaid care managers will assist all eligible individuals to enroll in SNAP and WIC and secure their enrollment through existing SNAP and WIC assistance resources. Food and Nutrition Access Case Managers will address more complex and specialized needs. However, if under exceptional circumstances a Food and Nutrition Access Case Manager identifies an individual for whom all other forms of assistance have been ineffective, they are permitted to assist the individual with completing enrollment, including activities such as addressing documentation challenges or contacting staff at a local SNAP or WIC agency to resolve issues, or otherwise.
Setting
May be offered:
At a community setting (e.g. community center, health care clinic,
Via telephone or other modes of direct communication
Minimum Eligibility Criteria
Services are authorized in accordance with PHP authorization policies, such as but not limited to service being indicated in the enrollee's person-centered care plan.
Enrollee is not currently receiving duplicative support through other Pilot services.
Enrollee is not currently receiving duplicative support through other federal, state, or locally-funded programs.
Fruit and Vegetable Prescription
Service Description
IAM will provide enrollees with a Fruit & Vegetable order containing fresh, frozen and/or canned fruits and vegetables.
Frequency
One order per enrollee per week. Duration 6 months (on average) contingent on the determination of continued Pilot eligibility.
Minimum Eligibility Criteria
Enrollee has a diet or nutrition-related chronic illness, including but not limited to underweight, overweight/obesity, nutritional deficiencies, prediabetes/diabetes, hypertension, cardiovascular disease, gestational diabetes or history of gestational diabetes, history of low birth weight, or high risk pregnancy.
If potentially eligible for SNAP and/or WIC, the enrollee must either:
—Be enrolled in SNAP and/or WIC, or
—Have submitted a SNAP and/or WIC application within the last 2 months,
—or Have been determined ineligible for SNAP and/or WIC within the past 12 months
Services are authorized in accordance with PHP authorization policies, such as but not limited to service being indicated in the enrollee’s person-centered care plan.
Enrollee is not currently receiving duplicative support through other federal, state, or locally-funded programs.
Healthy Food Box (Pick-up)
Service Description
A healthy food box for pick-up consists of an assortment of nutritious foods provided to an enrollee in a community setting, aimed at promoting improved nutrition for the service recipient. It is designed to supplement the daily food needs for food-insecure individuals with diet or nutrition-related chronic illnesses. This service does not constitute a full nutritional regimen (three meals per day per person).
Frequency
Typically weekly
Duration
On average, this service is delivered for 3 months. Service would continue until services are no longer needed as indicated in an individual’s person-centered care plan.
Setting
Food is sourced and warehoused by a central food bank, and then delivered to community settings by the food bank.
Food is offered for pick-up by the enrollee in a community setting, for example at a food pantry, community center, or a health clinic.
Minimum Eligibility Criteria
Enrollee has a diet or nutrition-related chronic illness, including but not limited to underweight, overweight/obesity, nutritional deficiencies, prediabetes/diabetes, hypertension, cardiovascular disease, gestational diabetes or history of gestational diabetes, history of low birth weight, or high-risk pregnancy.
If potentially eligible for SNAP and/or WIC, the enrollee must either:
—Be enrolled in SNAP and/or WIC, or
—Have submitted a SNAP and/or WIC application within the last 2 months,
—or Have been determined ineligible for SNAP and/or WIC within the past 12 months
Services are authorized in accordance with PHP authorization policies, such as but not limited to service being indicated in the enrollee’s person-centered care plan.
Enrollee is not currently receiving duplicative support through other federal, state, or locally-funded programs.
Healthy Food Box (Delivered)
Frequency
Typically weekly
Service Description
A healthy food box for delivery consists of an assortment of nutritious foods that is delivered to an enrollee’s home, aimed at promoting improved nutrition for the service recipient. It is designed to supplement the daily food needs for food-insecure individuals with diet or nutrition-related chronic illnesses. This service does not constitute a full nutritional regimen (three meals per day per person).
Duration
(if applicable)
On average, this service is delivered for 3 months. Service would continue until services are no longer needed as indicated in an individual’s person-centered care plan.
Setting
• Food is sourced and warehoused by a central food bank.
• Food boxes are delivered to enrollee’s home.
Minimum Eligibility Criteria
Enrollee does not have the capacity to shop for themselves or get to food distribution site or have adequate social support to meet these needs.
Enrollee has a diet or nutrition-related chronic illness, including but not limited to underweight, overweight/obesity, nutritional deficiencies, prediabetes/diabetes, hypertension, cardiovascular disease, gestational diabetes or history of gestational diabetes, history of low birth weight, or high-risk pregnancy.
If potentially eligible for SNAP and/or WIC, the enrollee must either:
—Be enrolled in SNAP and/or WIC, or
—Have submitted a SNAP and/or WIC application within the last 2 months, or
—Have been determined ineligible for SNAP and/or WIC within the past 12 months
Enrollee is not currently receiving duplicative support through other federal, state, or locally-funded programs.
Services are authorized in accordance with PHP authorization policies, such as but not limited to service being indicated in the enrollee’s person-centered care plan.
Healthy Meal (For Pick-Up)
Service Description
A healthy meal for pick-up consists of a frozen or shelf-stable meal that is provided to an enrollee in a community setting, aimed at promoting improved nutrition for the service recipient. This service includes the preparation and dissemination of the meal.
Meals may be tailored to meet cultural preferences and specific medical needs. This service does not constitute a full nutritional regimen (three meals per day per person).
Setting
Frequency of meal services will differ based on the severity of the individual’s needs. Meals are offered for pick-up in a community setting, for example at a food pantry, community center, or a health clinic.
Duration
(if applicable)
Service would continue until services are no longer needed as indicated in an individual’s person-centered care plan, contingent on determination of continued Pilot eligibility.
Minimum Eligibility Criteria
Enrollee does not have the capacity to shop and cook for themselves or have adequate social support to meet these needs.
Enrollee has a diet or nutrition-related chronic illness, including but not limited to underweight, overweight/obesity, nutritional deficiencies, prediabetes/diabetes, hypertension, cardiovascular disease, gestational diabetes or history of gestational diabetes, history of low birth weight, or high-risk pregnancy.
If potentially eligible for SNAP and/or WIC, the enrollee must either:
—Be enrolled in SNAP and/or WIC, or
—Have submitted a SNAP and/or WIC application within the last 2 months, or
—Have been determined ineligible for SNAP and/or WIC within the past 12 months
Services are authorized in accordance with PHP authorization policies, such as but not limited to service being indicated in the enrollee’s person-centered care plan.
Enrollee is not currently receiving duplicative support through other federal, state, or locally-funded programs.
Healthy Meal (Home Delivered)
Service Description
A healthy, home-delivered meal consists of a hot, cold, or frozen meal that is delivered to an enrollee’s home, aimed at promoting improved nutrition for the service recipient. This service includes the preparation and delivery of the meal.
Meals may be tailored to meet cultural preferences and specific medical needs. This service does not constitute a full nutritional regimen (three meals per day per person).
Frequency
(if applicable)
Meal delivery services for enrollees requiring this service will differ based on the severity of the individual’s needs. On average, individuals receive 2 meals per day (or 14 meals per week).
Duration
(if applicable)
Service would continue until services are no longer needed as indicated in an individual’s person-centered care plan, contingent on the determination of continued Pilot eligibility.
Setting
Minimum: Meals are delivered to enrollee’s home
Eligibility Criteria
Social support to meet these needs.
Enrollee has a diet or nutrition-related chronic illness, including but not limited nto underweight, overweight/obesity, nutritional deficiencies, prediabetes/diabetes, hypertension, cardiovascular disease, gestational diabetes or history of gestational diabetes, history of low birth weight, or high-risk pregnancy.
If potentially eligible for SNAP and/or WIC, the enrollee must either:
—Be enrolled in SNAP and/or WIC, or
—Have submitted a SNAP and/or WIC application within the last 2 months, or
—Have been determined ineligible for SNAP and/or WIC within the past 12 months
Services are authorized in accordance with PHP authorization policies, such as but not limited to service being indicated in the enrollee’s person-centered care plan.
This service is not covered as a Pilot service if the receiving individual would be eligible for substantially the same service as a Medicaid-covered service.
Enrollee is not currently receiving duplicative support through other federal, state, or locally-funded programs.
Setting
Nutrition assessment is conducted in person, in a clinic environment, the enrollee’s home, or telephonically as appropriate.
Meals are delivered to the enrollee’s home.
Minimum Eligibility Criteria
Enrollee does not have the capacity to shop and cook for themselves or have adequate social support to meet these needs.
Eligible disease states include but are not limited to obesity, failure to thrive, slowed/faltering growth pattern, gestational diabetes, pre-eclampsia, HIV/AIDS, kidney disease, diabetes/pre-diabetes, and heart failure.
If potentially eligible for SNAP and/or WIC, the enrollee must either:
—Be enrolled in SNAP and/or WIC, or
—Have submitted a SNAP and/or WIC application within the last 2 months, or
—Have been determined ineligible for SNAP and/or WIC within the past 12 months
Services are authorized in accordance with PHP authorization policies, such as but not limited to service being indicated in the enrollee’s person-centered care plan.
Enrollee is not currently receiving duplicative support through other Pilot services.
This service is not covered as a Pilot service if the receiving individual would be eligible for substantially the same service as a Medicaid-covered service.
Enrollee is not currently receiving duplicative support through other federal, state, or locally-funded programs.
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Transportation Services
Reimbursement for Health-Related Public Transportation
Service Description
Provision of health-related transportation for qualifying Pilot enrollees through vouchers for public transportation via Apple Country Public Transit only.
This service may be furnished to transport Pilot enrollees to non-medical services that promote community engagement, health and well-being. The service may include transportation to locations indicated in an enrollee’s care plan that may include, for example:
Grocery stores/farmer’s markets;
Job interview(s) and/or place of work;
Places for recreation related to health and wellness (e.g., public parks and/or gyms);
Group parenting classes/childcare locations;
Health and wellness-related educational events;
Places of worship, services and other meetings for community support;
Locations where other approved Pilot services are delivered.
Pilot transportation services will not replace non-emergency medical transportation as required in Medicaid.
Minimum Eligibility Criteria
Family, neighbors and friends are unable to assist with transportation
Public transportation is available in the enrollee’s community.
Service is only available for enrollees who do not have access to their own or a family vehicle.
Services are authorized in accordance with PHP authorization policies, such as but not limited to service being indicated in the enrollee’s person-centered care plan.
Enrollee is not currently receiving duplicative support through other Pilot services.
Enrollee is not currently receiving duplicative support through other federal, state or locally-funded programs.
Reimbursement for Health-Related Private Transportation
Service Description
Provision of private health-related transportation for qualifying Pilot enrollees by providing gas vouchers for non-medical, health-related transportation.
Non-Emergency Medical Transportation clinical policy
This service may be furnished to transport Pilot enrollees to non-medical services that promote community engagement, health and well-being. The service may include transportation to locations indicated in an enrollee’s care plan that may include, for example:
Grocery stores/farmer’s markets;
Job interview(s) and/or place of work;
Places for recreation related to health and wellness (e.g. public parks and/or gyms);
Group parenting classes/childcare locations;
Health and wellness-related educational events;
Places of worship, services and other meetings for community support;
Locations where other approved Pilot services are delivered.
Pilot transportation services will not replace non-emergency medical transportation as required in Medicaid.
Minimum Eligibility Criteria
Services are authorized in accordance with PHP authorization policies, such as but not limited to service being indicated in the enrollee’s person-centered care plan.
Enrollee is not currently receiving duplicative support through other Pilot services.
Enrollee is not currently receiving duplicative support through other federal, state, or locally-funded programs.
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