ARE YOU ELIGIBLE?

If you have Medicaid and live in Bladen, Brunswick, Columbus, New Hanover, Onslow, or Pender counties you may qualify for the Healthy Opportunities Program. This is a FREE PROGRAM through your Medicaid health plan.

To qualify for Healthy Opportunities Pilot services, Medicaid Managed Care enrollees in Standard Plans must live in a Pilot Region and have qualifying physical/behavioral health criteria and at least one social risk factor.

Eligibility Requirements

1

Medicaid Enrollees must have one physical or behavioral health condition

See All Conditions

Adults 21+

Two or more chronic conditions. Chronic conditions that qualify an individual for Pilot program enrollment include: BMI over 25, blindness, chronic cardiovascular disease, chronic pulmonary disease, congenital anomalies, chronic disease of the alimentary system, substance use disorder, chronic endocrine and cognitive conditions, chronic musculoskeletal conditions, chronic mental illness, chronic neurological disease and chronic renal failure, in accordance with Social Security Act section 1945(h) (2).
Repeated incidents of emergency department use (defined as more than four visits per year) or hospital admissions.

Pregnant Women

Multifetal gestation
Chronic condition likely to complicate pregnancy, including hypertension and mental illness
Current or recent (month prior to learning of pregnancy) use of drugs or heavy alcohol
Adolescent < 15 years of age
Advanced maternal age, ≥ 40 years of age
Less than one year since last delivery
History of poor birth outcome including: preterm birth, low birth weight, fetal death, neonatal death

Children (0 – 3)

Neonatal intensive care unit graduate
Neonatal Abstinence Syndrome
Prematurity, defined by births that occur at or before 36 completed weeks gestation
Low birth weight, defined as weighing less than 2500 grams or 5 pounds 8 ounces upon birth
Positive maternal depression screen at an infant well-visit

Children (0 – 20)

One or more significant uncontrolled chronic conditions or one or more controlled chronic conditions that have a high risk of becoming uncontrolled due to unmet social need, including: asthma, diabetes, underweight or overweight/obesity as defined by having a BMI of <5th or >85th percentile for age and gender, developmental delay, cognitive impairment, substance use disorder, behavioral/mental health diagnosis (including a diagnosis under DC: 0-5), attention deficit/hyperactivity disorder, and learning disorders
Experiencing three or more categories of adverse childhood experiences (e.g. Psychological, Physical, or Sexual Abuse, or Household dysfunction related to substance abuse, mental illness, parental violence, criminal behavioral in household)
Enrolled in North Carolina’s foster care or kinship placement system
Cancer and autoimmune diseases