NC budget could cut groundbreaking Medicaid program that helps with food, housing | Opinion
When North Carolina’s Healthy Opportunities Pilots (HOP) officially launched in 2022, it sought to answer a simple, but ambitious, question: Would using Medicaid to address socioeconomic disparities improve people’s health?
The program, which is the first of its kind in the nation, uses Medicaid dollars to address the various social factors that contribute to health, such as food and housing. It’s based upon the belief that people’s health and well-being are heavily influenced by the conditions in which they live. By improving those conditions, the program hypothesized, health outcomes will improve and medical costs will fall.
That hypothesis was correct. HOP has led to fewer medical interventions and lower health care costs for the tens of thousands of people who have received its services — but its future is at risk if North Carolina lawmakers do not continue to fund it. Preliminary budget proposals from both the state House and Senate do not include funding for the program, despite the fact that the N.C. Department of Health and Human Services has received federal approval to continue it for another five years.
Studies show that social determinants of health have a greater impact on health outcomes than medical care provided by doctors. So the program covers the cost of services like healthy food boxes, public transportation, home repairs, the security deposit for a lease and therapy for victims of domestic violence. The services are provided through a coordinated network of nonprofits and community partners. To be eligible, Medicaid enrollees must have at least one qualifying physical or behavioral health condition and one qualifying social risk factor, such as housing insecurity, food insecurity or risk of interpersonal violence.
The program has objectively been a success. A independent evaluation released last year found that people who received services through HOP had fewer emergency department visits and hospitalizations. And the longer they participated in the program, the more their food, housing and transportation needs were reduced. It’s also saved the state money — the state is spending an average of $85 dollars less per month on medical costs for each person participating in the program.
It makes sense. Being unable to afford healthy food, living in unsafe or unstable conditions, avoiding visits to the doctor because you don’t have a way to get there — all of those things make it harder for someone to be truly healthy. And it costs the state much less to improve any of those things than it does to provide the medical attention someone needs when their health worsens.
“I’ve been in and around Medicaid for about 18 years, and I have never seen a program as effective as this program is in terms of improving health, improving and strengthening local communities,” Jay Ludlam, deputy secretary of the state’s Medicaid program, told me.
HOP is funded through what’s known as a Section 1115 waiver, which gives states the flexibility to test new approaches to delivering Medicaid services. A large portion of HOP’s funding comes from the federal government — but that funding is contingent upon the state providing the remainder.
Currently, the program is implemented in 33 of North Carolina’s 100 counties, but DHHS also received approval to expand it statewide. Funding to continue the current program is not included in either budget proposal, let alone additional funding that would allow the program to expand. Without that funding, the program is effectively on the chopping block.
“We need funding to run this program,” Ludlam said.
Representatives for House Speaker Destin Hall and Senate leader Phil Berger did not respond to a request for comment.
Cutting the program would be bad for North Carolina — but it would also be bad for other states who can learn from the program’s continued successes. While some states have programs that seek to improve health outcomes by targeting one specific socioeconomic factor, HOP provides a comprehensive approach by offering a broader list of services. It’s a radical experiment that has had meaningful results.
“This is strengthening community. It’s a good, good program for North Carolina. We’re saving the state money. We’re making people healthier,” Ludlam said. “It seems like the right investment.”
