NC’s Healthy Opportunities Pilot is coming back — but not at full strength

By Jaymie Baxley 

DeBorah Ogiste is among the more than 30,000 North Carolinians who have received services through the state’s Healthy Opportunities Pilot.

Launched in 2022, the groundbreaking program was the first in the country to use Medicaid dollars to meet the non-medical health needs of qualifying beneficiaries in three largely rural regions of the state. In Ogiste’s case, that meant a crew came to remove mold from her home in Hendersonville in western North Carolina.

She lives there with her grandson, an 11-year-old Medicaid recipient who Ogiste said was born prematurely and has “some lung and autoimmune issues.” Before the mold abatement, he would frequently spend days in the hospital with breathing problems.

“They came in and they were able to pull up the floors in his room and his bathroom,” Ogiste said. “Since then, he’s only been hospitalized once — and that was just for overnight observation because of his history.”

Her experience reflects the idea at the heart of HOP: Investing in people’s basic needs up front could keep them healthier. That, in turn, can save dollars in Medicaid, the state and federally funded program that supports low-income children, some of their parents, low-income seniors and many people with disabilities. 

HOP provided rural residents like Ogiste with other services, ranging from weekly deliveries of fresh food to rides to doctors’ appointments. But that assistance ground to a halt in June 2025 after state lawmakers failed to approve the funding needed to continue the program.

“I was very disappointed,” Ogiste said of the pause. “Not just for myself but for my community.”

The interruption lasted more than a year, even as state health officials and advocates pointed to evidence that the program was improving health outcomes and reducing annual Medicaid spending by as much as $1,020 per recipient. In addition to helping beneficiaries, one analysis showed that HOP also generated $384 million in business activity and supported close to 3,000 jobs.

It took time, but lawmakers eventually came around. The state budget that passed earlier this summer earmarked $25 million in nonrecurring funds to restart HOP — an allocation that fell well short of the $80 million that had been requested.

Despite the funding gap, the organizations charged with overseeing the program in their respective regions — Access East in the northeastern part of the state, Community Care of the Lower Cape Fear in the southeast and Impact Health in the western mountains — say the money will allow them to resume some services.

Exactly which services will return — and when — is uncertain.

A cautious restart

Laurie Stradley, CEO of Impact Health, said rebuilding the program’s operations won’t happen overnight.

“It’s a machine, and it’s going to take some work to get it back up and running at the rate it was when Healthy Opportunities stopped,” said Stradley, whose organization administered the program in 18 western counties.

HOP relies on a layered network of administration, local partners and outreach workers to reach people in their communities. In each region, a “network lead” such as Impact Health contracts with local nonprofits and small businesses to deliver the program’s services on the ground.

Across the three regions, more than 140 of these community partners coordinated the distribution of goods and services to enrollees. In western North Carolina, for instance, Impact’s network includes the Caja Solidaria food bank, which used HOP funding to distribute boxes of fresh fruit and vegetables to participants.

Impact Health had been serving about 14,000 people in its region when HOP funding was frozen. Before the stoppage, the organization reimbursed its network of community partners nearly $10 million a month in state and federal funds.

The new funding will not be enough to return to that scale this year, Stradley said. Instead, she sees the current fiscal year as an opportunity to restart the program, rebuild relationships and prepare for a fuller revival in the next state budget cycle.

Some services, however, could return relatively quickly. Stradley said Impact Health feels confident that many of its food-related interventions such as home-delivered meals and produce “prescriptions” could be restored soon after the state gives the go-ahead. 

Other services may take longer to restore, particularly because the program’s new Medicaid waiver is different from the original one.

Under the new waiver, transportation is no longer authorized as a standalone HOP intervention. Stradley said services such as car repairs — particularly valuable in rural communities where an engine problem can translate into an inability to get to work — will not return in their previous form.

“We live in rural North Carolina, where your car is your lifeblood,” she said. “The ability to help someone get their car back on the road [is] truly life-changing.”

Transportation may still be available in some circumstances as part of another HOP service, such as helping someone get to a location to pick up a food box, according to Sarah Ridout, director of community programs at Community Care of the Lower Cape Fear, whose network covers six southeastern counties.

But the N.C. Department of Health and Human Services has not yet told the network leads exactly which services will be funded nor provided a timeline for distributing the $25 million.

Ridout said the department is assessing the condition of the three HOP networks as it develops a plan for how to use the money. That means the organizations that administer HOP are preparing without knowing exactly when they will be called back into action or which services they will be able to offer.

“We are, as network leads, waiting to find out how that is all going to roll out,” Ridout said.

Partners are ready

The community-based organizations that delivered HOP services have been largely enthusiastic about the prospect of a restart, Ridout said.

During the pause, Community Care of the Lower Cape Fear kept communicating with its local partners and provided training and other support to keep them engaged. 

“I think they finally felt heard and really excited [when the funding was approved],” Ridout said. “I think they also certainly recognized that while HOP paused, the need did not.”

Community health workers have told Ridout they are glad to see HOP get a second chance. So have people whose services were suspended.

She recalled one person saying HOP services had helped them stay in college. Another parent told her the program had been instrumental in helping care for a son with disabilities while maintaining work and other responsibilities.

For care managers, Ridout said, HOP was another way to help people address barriers that can harm their health.

“When you are in care management, you are connecting those members back to their health,” she said. “You are meeting them where they are.”

Without resources to address food insecurity, housing instability or other needs, care managers can struggle to help people achieve their health goals — and people can become disengaged from their care plans.

“We’ve heard community health workers say they’re so excited to see this come back,” Ridout said. “This was a huge resource in their communities and a really great tool.”

Ridout said the evidence that HOP was making a difference helped sustain enthusiasm for the program during the pause.

She pointed to a report published in March by the Cecil G. Sheps Center for Health Services Research that estimated that HOP was associated with $164 less in health care spending per participant per month, on average, over the program’s first 32 months.

“We knew it worked, and that gave us the numbers and the data to back it up,” she said.

What’s next

Two of the network leads for HOP are also involved in North Carolina’s Rural Health Transformation Program, which is funded through a federal initiative designed to boost care delivery and expand access to services in rural communities. 

Impact and Access East are among the five organizations tapped to lead what the state is calling ROOTS Hubs. Short for Rural Organizations Orchestrating Transformation for Sustainability, the hubs are designed to carry out the goals of the Rural Health Transformation Program across the state’s six Medicaid regions.

Access East did not respond to an interview request.

The rural health initiative could complement HOP, but its federal funding cannot be used to pay directly for services such as food, transportation or housing repairs. Instead, the money is intended for infrastructure such as care coordination, workforce development and needs assessments.

Stradley said Impact Health sees the two efforts as complementary: Rural Health Transformation can build the infrastructure, while HOP and other programs can provide the services.

“We’re really excited to be able to strengthen the infrastructure so that even as Healthy Opportunities probably transitions over the next three to five years to different versions, we’ll have the infrastructure really stabilized,” she said.

For now, though, the immediate question is when the more limited HOP itself will return.

Stradley said Impact Health has been sharing information with NC DHHS about its readiness and talking with community partners about how quickly they could resume services.

“We’re all sort of at the edge of our seats, ready to be directed by the state when they have all the details that they need,” she said.

Ridout said Community Care of the Lower Cape Fear is in a similar position.

“Our network is ready,” she said. “We’re excited. We’re invested.”

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