Trillium providers can begin receiving HOP Referrals on May 15th, 2024

This form may be used by Trillium contracted providers who are supporting Trillium members who are receiving Tailored Care Management, but are NOT contracted to do Pilot/HOP or a Trillium provider supporting a Trillium member via HFW or ACT.

Referrals for members who are believed to be eligible for the Healthy Opportunities Pilot may be assessed for the Pilot by Trillium. Please be able to answer the below questions with YES prior to submitting the referral form.

• Does the member reside in a Pilot County?
• Is the member receiving TCM/ACT/HFW?
• Is the member experiencing a social risk factor in one or more of the following areas;
• Housing
• Food
• Transportation
• Toxic Stress/Interpersonal Safety

Before a referral is made, the TCM/HFW/ACT Provider will ensure:

• The member understands they will need to complete a Pilot eligibility and service assessment to determine eligibility for Pilot Services - eligibility it NOT guaranteed.
• The member understands that if found eligible, they must be willing to complete consents for NCARE360 & the Pilot in order to participate. This means the member is consenting to their information being entered into this database and their information is being shared with Human Service Organizations (HSOs)
• Oher available resources have been explored (and documented in this form) prior to sending the referral to Trillium.
• The member understands that this is a PILOT and availability of PILOT services are dependent on capacity, funding and other factors.
• The member has a SDOH related goal in their ISP/Care Plan at the time of referral.