North Carolina’s Healthy Opportunities Pilot is preparing to resume after more than a year without services — but the $25 million state lawmakers approved for the restart is less than a third of the $80 million that program administrators had requested, according to NC Health News.
The program, which launched in 2022, was the first in the country to use Medicaid dollars to pay for targeted, non-medical services — including healthy food deliveries, housing supports, and transportation — for qualifying low-income patients in three largely rural regions of North Carolina. More than 31,000 people enrolled between the program’s launch and November 2024.
A study by the University of North Carolina’s Cecil G. Sheps Center for Health Services Research found that the program saved Medicaid an average of $164 per participant per month — after accounting for the cost of every service and all administrative overhead. Participants had fewer emergency department visits and hospital admissions, and more contact with less-expensive outpatient providers like primary care practices. Nearly 90 percent of participants reported that HOP improved their health or their children’s health, according to an op-ed in STAT News co-written by two former North Carolina health secretaries who helped design the program.
None of that was enough to keep state lawmakers from cutting the funding. The Centers for Medicare and Medicaid Services had authorized the program to continue through December 2029, but the North Carolina General Assembly failed to appropriate a state match after July 1, 2025, forcing the program to suspend operations.
For the people who relied on those services, the pause was immediate. In Wilmington, Cynthia Brock — a single parent of five living on disability — had used the program to pay a security deposit on a new rental home and to get new tires so she could drive her children to doctor’s appointments. Since HOP ended, she told WHQR public radio, “It helped a lot when I needed help, but now, I just try to do what I can as a single parent and make sure I have the lights on for my kids.”
Community organizations that had built their service models around HOP felt the gap equally. “You’re looking at someone who we could help to the tune of $2,000,” said Meade Van Pelt, executive director of The Jo Ann Carter Harrelson Center in Wilmington. “We’re now back to $200. In today’s environment, that’s just not enough to solve a problem.”
The new state budget, signed into law in July, provides $9 million in state funds and $16 million in federal matching dollars — enough to restart the program at reduced scale, but not to rebuild it. The three regional network administrators — Impact Health in western NC, Community Care of the Lower Cape Fear in the southeast, and Access East in the northeast — say they are ready to begin, but the state health department has not yet told them which services will be covered or when money will flow.
Food-related services such as home-delivered meals and produce “prescriptions” are likely to return first. But transportation — which had included car repairs for rural residents who have no alternatives to driving — will not come back in its previous form, because the program’s new Medicaid waiver no longer authorizes transportation as a standalone service.
“We live in rural North Carolina, where your car is your lifeblood,” said Laurie Stradley, CEO of Impact Health, which administered HOP across 18 western counties and was reimbursing its network of community partners nearly $10 million a month before the funding was cut. “The ability to help someone get their car back on the road [is] truly life-changing.”
The program was built in 2018 with support from the first Trump administration and North Carolina’s Republican-controlled legislature, alongside Democratic Gov. Roy Cooper’s administration — an alignment of fiscal conservatism and public health evidence that the program’s architects now argue should be replicated nationally. Whether North Carolina will fund it at the scale its results appear to justify remains a question for the next budget cycle.