North Carolina’s healthy Opportunities Pilots Face Uncertainty Amidst Budgetary shifts
North carolina’s innovative Healthy Opportunities Pilots (HOP), designed to address social determinants of health for Medicaid beneficiaries, are currently inactive and face an uncertain future due to evolving state budgetary priorities. The program’s fate is intertwined with broader discussions surrounding Medicaid expansion, though officials emphasize they are distinct policy questions – both, however, are impacted by anticipated reductions in available Medicaid funding.
HOP originated as part of a Medicaid 1115 waiver approved in 2018 by the Centers for Medicare & Medicaid Services (CMS) under then-Administrator Seema verma during the Trump management. This waiver uniquely combined Medicaid managed care – a Republican priority – with the social determinants of health pilot, a Democratic initiative. Implementation occurred under the leadership of North Carolina Health and Human Services Secretaries Mandy Cohen (later Director of the CDC under the Biden administration) and subsequently Kody Kinsley.
The pilot program, launched after a multi-year rollout of the broader Medicaid managed care system, operated in three regions encompassing roughly a third of North Carolina’s counties, intentionally focusing on more rural areas. Notably, the pilot did not include major metropolitan areas like Charlotte or the Research Triangle. One pilot region included Asheville and surrounding counties, providing services in an area considerably impacted by Hurricane Helene one year prior.
A recent UNC-Duke report evaluating the program, covering the period from March 2022 to November 2023, did not yield statistically significant conclusions regarding health outcomes. However, researchers endorsed extending and expanding the pilot, stating it “provides an crucial opportunity for North Carolina to shift Medicaid costs toward prevention while achieving longer-term savings on state health care spending, with better health outcomes and more resilient communities.”
Early in the summer, the program enjoyed some bipartisan support.State Senator Jim Burgin, chair of the Senate Health Committee, and Representative timothy Reeder, a member of the house Health Committee and practicing emergency physician, publicly expressed openness to extending HOP funding.However,subsequent attempts to secure comment from both lawmakers regarding their current positions were unsuccessful.
The North Carolina Department of Health and Human Services confirmed the pilot is currently inactive but declined to comment further on its prospects.
Dr. Adam McClellan, a physician and economist involved with the program, remains optimistic that some form of the initiative will continue. He suggests potential stopgap measures,including continued utilization of the state’s UniteUs platform (NC360) and the possibility of Medicaid managed care plans independently funding services like food assistance for high-need patients.He also points to potential alignment with the MAHA (make America Healthy Again) movement and policies potentially favored by current HHS Secretary Robert F.Kennedy jr., particularly regarding healthy food and nutrition.
“I think some version is going to continue,” McClellan stated. “The question is: How big and bold is it going to be?”
