Good Shepherd Food Pantry of Bertie County, NC Inc, The

FIGHTING HUNGER AND POVERTY IN BERTIE COUNTY FOR OVER 16 YEARS.

Who Does HOP Serve?

Do you qualify?

The Good Shepherd Food Pantry is part of a robust network of human service organizations (HSOs) that provide housing, transportation, food and/or interpersonal safety services to eligible NC Medicaid Managed Care members enrolled in the Healthy Opportunities Pilot. We provide only Healthy Food Boxes under this program.

To be eligible for pilot services, individuals must:

Be enrolled in an NC Medicaid Managed Care health plan,
Must live in Bertie or Chowan County.
Have a qualifying physical or behavioral health condition +
a qualifying social need or risk factor.

HOP Services

If you are enrolled in NC Medicaid Managed Care, you may be eligible for services to support your wellbeing at no cost to you.

The Healthy Opportunities Pilot (HOP) may be able to help you access fresh healthy food, safe housing, reliable transportation and personal safety services. These factors are as important as visits to the doctor and can even help prevent them. Depending on your circumstances, you may be eligible for some of the following services listed below.

Food

Help finding and getting nutritious food.
Group nutrition classes.
Diabetes prevention education.
Credits to purchase fruits and vegetables.
Groceries for pick-up or home delivery.
Healthy prepared meals for pick-up or home delivery.
Home-delivered meals that meet your medical dietary needs.

Transportation

Support your wellness such as the grocery store, work, church or a support group.
Taxi and ride-sharing credits where public transportation is unavailable.
Vehicle repairs

Personal Safety & Healthy Relationships

Parenting curriculum
In-home services
Interpersonal violence case management
Violence intervention services

Housing

Support for finding stable, long-term housing.
One-time security deposit and first month’s rent.
Move-in support, such as arranging for a moving company.
Help setting up utilities and getting furniture.
Healthy home goods, such as an air purifier or a new mattress.
Home inspection to ensure safety and quality.
Help with home issues like mold.
Home accessibility and safety modifications.
Short-term post-hospitalization housing.

Other Services

Medical support for people experiencing homelessness
Legal support to address issues that impact your health, including
- maintaining safe housing and personal safety.

Pilot Eligibility: Physical/Behavioral Health Criteria.

NC Medicaid Managed Care members must meet at least one physical/behavioral health criteria and one social risk factor to be eligible for the Pilot program.

Adults 21+

Chronic conditions that qualify an individual for pilot 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, chronic infectious disease, cancer, autoimmune disorders, chronic liver 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.
Former placement in North Carolina’s foster care or kinship placement system.
Previously experienced three or more categories of adverse childhood experiences (ACEs)
Intellectual or developmental disability (I/DD) and traumatic brain injury (TBI)
Meeting clinical criteria for Tailored Care Management (TCM)

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
Former or current placement in NC’s foster care or kinship placement system
Previously experienced or currently experiencing three or more categories of ACEs
Intellectual or developmental disability (I/DD) and traumatic brain injury (TBI)
Meeting clinical criteria for Tailored Care Management (TCM)

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, chronic infectious disease, cancer, autoimmune disorders, chronic liver disease
Experiencing or previously experienced 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)
Former placement in NC’s foster care or kinship placement
Intellectual or developmental disability (I/DD) and traumatic brain injury (TBI)
Meeting clinical criteria for Tailored Care Management (TCM)
Cancer and autoimmune diseases

Pilot Eligibility: Social Risk Factors

Homelessness and housing insecurity

Homelessness, as defined in 42 C.F.R. § 254b(h)(5)(A), or housing insecurity, as defined based on the principles in the questions used to establish housing insecurity in the Accountable Health Communities Health Related Screening Tool or the North Carolina Social Determinants of Health (SDOH) screening tool.1,2</sup

Food insecure

As defined by the US Department of Agriculture commissioned report on Food Insecurity in America:3

Low Food Security: reports of reduced quality, variety, or desirability of diet. Little or no indication of reduced food intake.
Very low food security: Reports of multiple indications of disrupted eating patterns and reduced food intake

Or food insecure as defined based on the principles in the questions used to establish food insecurity in the North Carolina Social Determinants of Health (SDOH) screening tool.4

Transportation insecure

Defined based on the principles in the questions used to establish transportation insecurities in the Accountable Health Communities Health Related Screening Tool or the North Carolina SDOH screening tool.5

At risk of, witnessing or experiencing interpersonal violence

Defined based on the principles in the questions used to establish interpersonal violence in the Accountable Health Communities Health Related Screening Tool or the North Carolina SDOH screening tool.6

More info

1 The Accountable Health Communities Health-Related Social Needs Screening Tool. Available https://innovation.cms.gov/files/worksheets/ahcm-screeningtool.pdf.

2 North Carolina’s SDOH Screening Questions. Available:
https://www.ncdhhs.gov/about/department initiatives/healthy-opportunities/screening-questions

3 USDA Economic Research Service [Internet]. Washington: USDA Economic Research Service; [updated 2017 Nov 27]. Definitions of Food Insecurity; [updated 2017 Oct 4; cited 2017 Nov 27]. Available from: https://www.ers.usda.gov/topics/food nutrition-assistance/food-security-in-the-us/definitions-of-food-security/

4 North Carolina SDOH Screening Tool. Available: https://www.ncdhhs.gov/about/department-initiatives/healthy opportunities/screening-questions

HOP Screening Questions

Thank you for your interest in the Healthy Opportunities Pilot (HOP). HOP is only available for Medicaid Managed Care recipients that lives in one of the 33 counties in North Carolina that HOP provides services for. To be pre-screened, please complete the questions below, and a Good Shepherd HOP Navigator will reach out to complete the pre-screening process.

Who are you completing this form for? (yourself or are you a parent or gradian of recipient)
Name of Medicaid Managed Care Recipient? (Enter first and last name)
County of Residence?
Medicaid Managed Care Plan Provider?
Member Medicaid ID number from Insurance/PHP Card? (Member ID is 9 digits and a letter; Member ID is not required, but will reduce processing delays)
Address, City and Zip Code? (required)
Date Of Birth? (Please enter for the Medicaid Managed Care recipient)
Best Phone Number to reach you?
Is it ok to leave a message? (Yes or No)
Is there a best time to reach you? (Insert best time)
How did you hear of HOP?

COPY AND ANSWER QUESTIONS IN EMAIL PROVIDED BELOW

Hello

Welcome To the Healthy Opportunity Pilot (HOP)!

Who Does HOP Serve?

Do you qualify?

HOP Services

If you are enrolled in NC Medicaid Managed Care, you may be eligible for services to support your wellbeing at no cost to you.

Food

Transportation

Personal Safety & Healthy Relationships

Housing

Other Services

Pilot Eligibility: Physical/Behavioral Health Criteria.

Adults 21+

Pregnant Women

Children 0-3

Children 0-20

Pilot Eligibility: Social Risk Factors

Homelessness and housing insecurity

Food insecure

Transportation insecure

At risk of, witnessing or experiencing interpersonal violence

More info

HOP Screening Questions

Am I Eligible?

Being healthy is more than a doctor's visit. Take charge!

Hello

Welcome To the Healthy Opportunity Pilot (HOP)!

Who Does HOP Serve?

Do you qualify?

HOP Services

If you are enrolled in NC Medicaid Managed Care, you may be eligible for services to support your wellbeing at no cost to you.

Food

Transportation

Personal Safety & Healthy Relationships

Housing

Other Services

Pilot Eligibility: Physical/Behavioral Health Criteria.

Adults 21+

Pregnant Women

Children 0-3

Children 0-20

Pilot Eligibility: Social Risk Factors

Homelessness and housing insecurity

Food insecure

Transportation insecure

At risk of, witnessing or experiencing interpersonal violence

More info

HOP Screening Questions

Am I Eligible?

Being healthy is more than a doctor's visit. Take charge!

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