As the Healthy Opportunities Pilots (HOP) program reaches its second anniversary, results from an independent study prove that the program is a success. 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.
Two years into the pilot, the state is spending about $85 less in medical costs per Healthy Opportunities Pilots (HOP) beneficiary per month. Findings also show participants avoided a significant number of emergency department visits and a segment of the participating population avoided inpatient hospitalizations. The evaluation concludes HOP 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 the reduction of risk and cost savings.
The evaluation considers the first 18 months of HOP service delivery, between March 2022 and November 2023. The department also tracks key metrics and since launching in March of 2022, more than 288,000 services have been delivered with over 20,000 NC Medicaid members enrolled across 33 counties as part of the pilots.
The program addresses non-medical drivers of health and has been described as a “life changer” for thousands of North Carolina families. It covers the cost of 28 services that target beneficiaries’ food, housing, transportation and interpersonal violence/toxic stress needs – the last of which was launched on April 5, 2023.
Throughout the past two years we have received numerous success stories from our communities, like this one from western North Carolina: Struggling to find enough food to feed her family, a mother enrolled in HOP. She is now receiving food boxes each week to help feed her family. “The food boxes have saved our life,” she said. "The food is amazing. The process is so helpful... There has never been a government program that has worked so well. I tell everybody about it!”
On average, each pilot member has received more than 19 service deliveries, with food services making up the majority. With housing and transportation services increasing, the number of Medicaid members receiving pilot services continues to rise quickly and increased over 192% between March 2023 and January 2024.
With the pilot program now underway, NCDHHS is focused on continually improving the program throughout all pilot regions. One area of focus since the program launched has been to increase awareness of and access to pilot services.
In partnership with pilot entities, the department is implementing several coordinated strategies to grow pilot enrollment and referrals to ensure eligible North Carolinians receive services that can improve their health and lower health care costs. Strategies include direct member outreach and streamlining the enrollment and referral process made by health plans, network leads and human services organizations to likely-eligible members.
HOP services are currently available to qualifying NC Medicaid Managed Care Standard Plan beneficiaries who live in a pilot region and have at least one qualifying physical or behavioral health condition and one qualifying social risk factor. NC Medicaid Direct members eligible for Tailored Care Management will be HOP eligible in late spring, with Tailored Plan members eligible in summer 2024. NCDHHS has submitted a new 1115 waiver proposal to the federal government to expand the pilots statewide.
To learn more about the Healthy Opportunities Pilots and how the program is helping Medicaid members in North Carolina, visit the HOP webpage or the HOP frequently asked questions. Read the full Interim Evaluation Report.