The Healthy Opportunities Pilots will cover the cost of 29 interventions defined and priced in the Department’s Pilot Service Fee Schedule. These services were selected based on their potential to improve health outcomes and/or lower health care costs and address the housing, food, transportation, interpersonal violence and toxic stress needs of qualifying Medicaid members.
Housing Navigation, Support and Sustaining Services: One-to-one case management and/or educational services to prepare an Enrollee for stable, long-term housing (e.g., identifying housing preferences and developing a housing support plan), and to support an Enrollee in maintaining stable, long-term housing(e.g., development of independent living skills, ongoing monitoring and updating of housing support plan).
Inspection for housing safety and quality: A housing safety and quality inspection by a certified professional includes assessment of potential home-based health and safety risks to ensure the living environment is not adversely affecting occupants’ health and safety. Inspections may assess the habitability and/or environmental safety of an Enrollee’s current or future dwelling.
Housing move-in support: Housing move-in support services are non-recurring set-up expenses. To include moving expenses to occupy and utilize the housing, discrete goods to support enrollee’s transition to stable housing.
Essential Utility Set-Up: 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.
Home Remediation Services: Home remediation services are coordinated and provided to eliminate known home-based health and safety risks to ensure living environment is not adversely affecting occupants’ health and safety. Home remediation services may include for example pest eradication, carpet or mold removal, installation of washable curtains or synthetic blinds to prevent allergens, or lead abatement.
Home Accessibility and Safety Modifications: Accessibility and safety modifications are coordinated and provided to eliminate known home-based health and safety risks to ensure living environment is not adversely affecting occupants’ health and safety. Home accessibility modifications are adjustments to homes that need to be made in order to allow for enrollee mobility, enable independent and safe living and accommodate medical equipment and supplies.
Healthy Home Goods: Home goods are furnished to eliminate known home-based health and safety risks to ensure the living environment is not adversely affecting occupants’ health and safety. Healthy Home Goods do not alter the physical structure of an Enrollee’s housing unit.
One-Time Payment for Security Deposit and First Month’s Rent: 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.
Short-Term Post Hospitalization Housing: Post-hospitalization housing for short-term period, not to exceed six  months, due to individual’s imminent homelessness at discharge from inpatient hospitalization. Coordination of this service should begin prior to hospital discharge by a medical professional or care team member.
Interpersonal Violence / Toxic Stress Services:
IPV Case Management Services: This service covers a set of activities that aim to support an individual in addressing sequelae of an abusive relationship. These activities may include: Safety planning/management, assistance with transition-related needs, linkages to child-care, community based social service and mental health agencies, referrals to legal support, coordination of transportation and peer counseling.
Violence Intervention Services: Delivery of services to support individuals who are at risk for being involved in community violence (i.e., violence that does not occur in a family context).
Evidence-Based Parenting Classes: Offered to families that may be at risk of disruption due to parental stress or difficulty coping with parenting challenges, or child behavioral or health issues. This service is also appropriate for newly reunited families following foster care/out of home placement or parental incarceration. Service to include group and one-on-one instruction to meet a variety of learning needs.
Home Visiting Services: Evidence-based home visiting services are offered to families that may be at risk of disruption due to parental stress or difficulty coping with parenting challenges, or child behavioral or health issues. Home Visiting Services are meant to provide one-on-one observation, instruction and support from a trained case manager.
Dyadic Therapy Services (start date delayed): Therapy to benefit a child/adolescent at risk for or with an attachment disorder, a behavioral or conduct disorder, a mood disorder, an obsessive-compulsive disorder, post-traumatic stress disorder, or as a diagnostic tool to assess for the presence of these disorders.
Food and Nutrition Access Case Management Services: One-on-one case management and/or educational services to assist an Enrollee in addressing food insecurity. Activities may include: Assisting an individual in enrolling in school meals, summer lunch programs; Child and Adult Care Food programs, or other benefits, assisting an individual in accessing other community-based food and nutrition resources, such as food pantries, farmers market voucher programs, cooking classes, and informational/educational materials and advising Enrollee on transportation-related barriers to accessing community food resources
Evidence-Based Group Nutrition Class: Covers an evidence-based or evidence-informed nutrition-related course to a group of individuals. Curricula provide interactive lessons to Enrollees, (i.e. increasing fruit and vegetable consumption, preparing healthy, balanced meals, growing food in a garden, and stretching food dollars).
Diabetes Prevention Program: A healthy living course delivered to a group of individuals by a trained lifestyle coach designed to prevent or delay type 2 diabetes. The program focuses on healthy eating and physical activity for those with prediabetes. Individuals with an existing DM diagnosis do not qualify for service.
Fruit and Vegetable Prescription: Food voucher to be used by an Enrollee with a diet or nutrition-related chronic illness to purchase fruits and vegetables from a participating food retailer, such as grocery stores, farmer’s markets, or produce subscription services.
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 illness.
Healthy Food Box (Home Delivered): Consists of an assortment of nutritious foods that is delivered to an Enrollee’s home, aimed at improving nutrition for the service recipient. It is designed to supplement the daily food needs for food-insecure individuals with diet or nutrition-related chronic illness.
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 improving nutrition for the service recipient. This service includes preparation and dissemination of the meal.
Healthy Meal (Home Delivered): A healthy, home-delivered meal consists of a hot, cold, or frozen meal that is delivered to an Enrollee’s home, aimed at improving nutrition for the service recipient. This service includes preparation and delivery of the meal.
Medically Tailored Home Delivered Meal: Home delivered meal which is medically tailored for a specific disease or condition. This service includes an initial evaluation with a Registered Dietitian Nutritionist (RD/RDN) or Licensed Dietitian Nutritionist (LDN) to assess and develop a medically-appropriate nutrition care plan, the preparation and delivery of the prescribed nutrition care regimen, and regular reassessment at least once every 3 months.
Reimbursement for Health-Related Public Transportation: Provision of health-related transportation for qualifying Pilot Enrollees through vouchers for public transportation. This service may be furnished to transport Pilot Enrollees to non-medical services that promote community engagement, health and well-being (i.e. transportation to grocery stores, job interviews, places of recreation, group parenting classes, and places of worship.
Reimbursement for Health-Related Private Transportation: Provision of private health-related transportation for qualifying Pilot Enrollees through services such as community transportation options, direct transportation by a professional, private or semi-private transportation vendor, and account credits for taxis or ridesharing mobile applications for transportation. This service may also include financial assistance for gas and/or vehicle repairs in certain circumstances.
Transportation PMPM Add-On for Case Management Services: Reimbursement for coordination and provision of transportation for Pilot Enrollees provided by an organization delivering one or more of the following case management services such as housing navigation support and support and sustaining services. Transportation must be to and from appointments related to identified case management goals.
Holistic High Intensity Enhanced Case Management: Provision of one-to-one case management and/or educational services to address co-occurring needs related to housing insecurity and interpersonal violence/toxic stress, and as needed transportation and food insecurities. Case management related to transportation needs are included.
Medical Respite Care: A short-term, specialized program focused on individuals who are homeless or imminently homeless, have recently been discharged from a hospital setting and require continuous access to medical care. Medical respite provides a stable setting and certain services for individuals who are too ill or frail to recover from a physical illness/injury while living in a place not suitable for human habitation, but are not ill enough to be in a hospital. Services may include short-term post-hospitalization housing and medically tailored meals delivered to residential settings and provision of private/semi-private transportation services.
Linkages to Health-Related Legal Supports: This service is to address legal matters in an effort to secure or maintain safe, healthy, affordable housing (currently live) and mitigate or eliminate exposure to interpersonal violence or toxic stress (start date Spring 2023). This service is limited to providing advice and counsel and does not include “legal representation.”