NC’s Healthy Opportunities Pilots Reduced Medicaid Costs by $164/Month Per Beneficiary

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A recent press release from the NC Dept. of Health and Human Services shares that, “North Carolina’s innovative Healthy Opportunities Pilots (HOP) reduced health care costs by an average of $164 per month for NC Medicaid beneficiaries, according to the results of a study announced today by the North Carolina Department of Health and Human Services. The study, conducted by the Cecil G. Sheps Center for Health Services Research at the University of North Carolina, found the program led to a significant shift in patient care. HOP participants had fewer emergency department visits and hospital stays and more visits with less-expensive outpatient providers like primary care practices.“

As the summative evaluation’s Research Summary 1-pager notes, “The savings were driven by a significant shift in patient care from Emergency Departments and inpatient hospital admissions to outpatient provider care. Participants also experienced a decrease in food, housing, and transportation needs.” The findings come from a multi-year evaluation completed by Cecil G. Sheps Center for Health Services Research at the University of North Carolina, and it supports the premise that tackling root causes of poor health outcomes can be cheaper than treating illness and injury after the fact.

NC Healthy Opportunities Pilots - An Innovative Approach to “Buying Health”

The NC HOP was “the nation’s first comprehensive program to test and evaluate the impact of providing select evidence-based, non-medical interventions related to housing, food, transportation and interpersonal safety and toxic stress to high-needs Medicaid enrollees.” (via NCDHHS). These pilots were conducted in three regions in NC, including Western North Carolina where the program was overseen by HOP Network Lead Impact Health. These pilots are part of an overarching paradigm shift away from paying for “sick care” toward “buying health,” i.e. redirecting funds to prevent illness and manage chronic disease to avoid the higher cost of treating those conditions once they’re become established or reached a crisis stage.

Under Impact Health’s leadership, the WNC HOP achieved undeniable success and, as the program’s needs evolved and grew, Impact Health developed an innovative set of operational, compliance and tracking systems through a partnership with software developer Vircho Health, the Pisgah Fund and other entities. These systems are now being considered as a model for statewide expansion of HOP and being looked at as a potential basis for national adoption of the program. Impact Health also cultivated a robust and thriving network of community organizations and non-profits across WNC to deliver HOP services that was unmatched across the state, and that generated significant economic impact for WNC. According to their “Health is Wealth” fact sheet, “In just three years, HOP spending led to more than $138 million in total business activity and created 1,111 full-time jobs that earned WNC workers more than $47 million in employment income. These impacts include direct spending and ripple effects that stimulate other parts of the economy.” In short, not only is providing a better quality of life for people before they fall ill (or before existing conditions worsen) create better health outcomes, it makes good economic sense beyond the healthcare sphere as well.

Another example of the HOP’s value can be seen in the response in the immediate aftermath of Hurricane Helene, which struck WNC in September of 2024. In the days following the storm, having a central organizational hub with a network of trusted and established service organizations already on the ground and deeply connected to their communities proved to be vital. Acting in partnership with Dogwood Health Trust, Impact Health was able to effectively and efficiently distribute emergency funds to their network of organizations, enabling them to deliver life-saving services to impacted families almost immediately, with minimal red tape or other barriers. “These grants have helped stabilize each agency as necessary by covering the costs for extra staffing, emergency building repairs, food, and other supplies in order to provide much-needed services to their community.” Without the pre-existing network that Impact Health had built through HOP, spinning up such a broad, regional response in such a short time would have been impossible.

Putting Success on Pause

Unfortunately, as a result of NC’s budget stalemate, funding for the HOP program was cut on June 30, 2025, shutting off services to the people, organizations, businesses, and communities who relied on them overnight. The program currently remains unfunded, although the General Assembly is working to finalize a state budget in the coming weeks and those advocating for this vital program remain hopeful that this budget will include renewed funding for HOP. We will provide updates on this issue and other policy news items as they develop.

NC Center for Health and Wellness HOP Impact Research

Researchers at the NC Center for Health and Wellness are also co-conducting research to better understand and share the impact of HOP services and supports in Western North Carolina. The NCCHW is working with groups on existing and new research and communication, and invites community members to get in touch if there is an opportunity to work with each other or support other work being done on this topic. Interested parties can contact Dr. Ameena Batada at abatada@unca.edu, or learn more about this research on their webpage.

Learn More

Summative Evaluation Report: NC Healthy Opportunities Pilots full text

Summative Evaluation Research Summary 1-pager

Healthy Opportunities Pilots Lead to Healthier Outcomes and Reduce NC Medicaid Costs (NCDHHS press release)

Healthy Opportunities Pilot info page

NCCHW Healthy Opportunities Research Webpage

Get Engaged

Impact Health “HOP Advocacy” page, where you can access informational documents, impact data and other information about HOP, as well as advocacy tools you can use to share your thoughts about the future of HOP and HOP funding with your government representatives.

Disclaimer

Individual opinions, findings, conclusions, or recommendations expressed in this post are those of the author(s)/interviewee(s) and do not necessarily reflect the view of the WNC Health Policy Initiative or its host institutions of the University of North Carolina Asheville (UNCA), Mountain Area Health Education Center (MAHEC) or our funders