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Healthy Opportunities Pilot Services: Member Rights and Responsibilities

Welcome to the Healthy Opportunities Pilot (HOP) program.

HOP is a trial program offered by NC Medicaid in three areas of North Carolina to those with certain health conditions and social needs. HOP offers Medicaid members non-medical services that Medicaid does not cover to help people's health.

WellCare of North Carolina will connect you to resources in your community to help you deal with issues beyond your medical care.

HOP services will be offered to you at no additional cost. WellCare of North Carolina and your care manager will help with your needs. HOP will not change your Medicaid eligibility or coverage. You may get food and nutrition services, housing services, transportation, interpersonal safety, and toxic stress services. These services focus on violence within the home or community and services dealing with long-term stress, such as abuse or trauma.

The following is need-to-know information about your coverage of HOP services. Keep these details in a safe place for you and your records.

  1. WellCare of North Carolina has decided that you qualify for the HOP program. HOP services will be available at no cost to you.

  2. You can choose not to take part in the HOP program at any time. You may revoke your consent to participate or share your personal health information (PHI) with the HOP program. Contact WellCare of North Carolina or your care manager.

  3. If you revoke consent, you can always change your mind. Contact WellCare of North Carolina or your care manager to be reevaluated for the program.

  4. You will become ineligible for HOP if you no longer have a qualifying health condition and social need, move outside of the HOP region, or are no longer enrolled in Medicaid Managed Care. If you no longer qualify for HOP services, or if funding for HOP services runs out, NC Medicaid will no longer pay for HOP services. If that happens, your care manager will work with you to find other services to help you. But, services outside the HOP program are subject to availability. NC Medicaid may not cover some non-HOP services, and you may need to pay for those services. Your care manager will work with you to find services you can afford.

  5. Your care manager will contact you to assess whether HOP services meet your needs at least once every three months. Your care manager will also check that you still qualify for benefits at least once every six months. You must take part in a service or eligibility reassessment every six months to get NC Medicaid-funded HOP services.

  6. If you take part in the needed reassessments, NC Medicaid will continue to pay for your HOP services until you no longer qualify for HOP services, do not need HOP services, or HOP funding is no longer available.

  7. If WellCare of North Carolina decides you no longer qualify for HOP services, you can request a reassessment if your health status or life events change. Call WellCare of North Carolina or your care manager to ask for one.

Filing a Grievance

You can file a grievance with WellCare of North Carolina by doing one of the following:

  • Calling our Member Services Line at 1-866-799-5318 (TTY: 711) Monday through Saturday, 7 a.m. to 6 p.m., Eastern time

    • After business hours, you may leave a message. We will contact you during the next business day.
       
  • You can write us at:

    WellCare of North Carolina
    Attn: Grievance Department
    PO Box 31384
    Tampa, FL 33631-3384

Questions?

If you have questions about the HOP program benefits, services, or resources, call our Member Services Line at 1-866-799-5318 (TTY: 711) Monday through Saturday, 7 a.m. to 6 p.m., Eastern time.

You can also visit our Healthy Opportunities website to learn more.