N.C. Legislature to Cut Funding for Healthy Opportunities Pilots

The North Carolina Department of Health and Human Services (NCDHHS) said that budget negotiations in the state Legislature do not include funding for the Healthy Opportunities Pilots (HOP) program’s ongoing operations or statewide scaling. The program addresses people’s social needs with services like food, housing, and transportation through Medicaid.

The notice on the  NCDHHS website said the “absence of available funding means that there is no funding scheduled for distribution to health plans for HOP service delivery beginning July 1, 2025. While new services are expected to stop beginning July 1, our hope is that this will only be a pause, and Healthy Opportunities can resume once additional funds are appropriated by the General Assembly.”


The Healthy Opportunities Pilots (HOP) is 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. The federal government has authorized up to $650 million in Medicaid funding for the Pilots over five years.

NC Medicaid is authorized to implement HOP via an 1115 waiver, for which it has received an extension. 

More than 288,000 services have been delivered and more than 20,000 NC Medicaid beneficiaries have enrolled across 33 predominantly rural counties in North Carolina as part of the Healthy Opportunities Pilots since the program began providing services two years ago. 

North Carolina said that preliminary research from the program’s independent evaluation shows the state is spending about $85 less in medical costs per Healthy Opportunities Pilots beneficiary per month. 

Those findings also show participants avoided a significant number of emergency department visits, and research shows participants have a reduced risk of food insecurity, housing instability and lack of access to transportation. Further, the findings showed that the longer a person was enrolled in the pilots the greater reduction of risk.

In an interview with NC Health News, Jay Ludlam, deputy secretary for NC Medicaid, said program participants expressed “disappointment” with the decision. “I think they’re disappointed, in part, because they understand and see every day the impact that this program is having on the people that they serve,” he said. “They know what we’ve built together, and what we risk losing if we’re unable to find funding.”

Rep. Donny Lambeth (R-Winston Salem) said in a text to NC Health News that the budget was too tight this year to continue funding the pilot program. He also said lawmakers haven’t seen enough “valid justification” to show the benefits outweigh the $175 million cost of the program for the next two years.