In The News: NC Medicaid’s Healthy Opportunities Pilot

News and EventsMedicaid Transformation
Written By Soni Pitts
A person in a blue shirt and nitrile gloves carrying bags of food across a yard.

Image by Khaosai Wongnatthakan, via Vecteezy

[Note: This post was edited on March 26, 2024 to reflect updated information and language, and to add additional resources.]

“90 percent of U.S. health care spending goes to medical care, but 80 percent of what affects a person’s health happens outside of a medical setting.” 

So says Harvard Public Health, in a feature article from the Fall 2023 issue. Those figures come from Elizabeth Tilson, NC state Health Director and Chief Medical Officer for the Department of Health and Human Services (DHHS), speaking on the rationale behind recent Medicaid investments in improving health outcomes by addressing the social determinants of health in the state’s most vulnerable populations. Tilson goes on to say that these investments represent “a commitment to ‘buying health, not just health care.’”

Understanding Social Determinants of Health

As defined by Healthy People 2030, “Social determinants of health (SDOH) are the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.“ SDOH include factors such as housing, transportation, economic stability, education, language and literacy skills, food and nutrition, interpersonal and community safety, social connection and so on. 

However, the site notes, “SDOH also contribute to wide health disparities and inequities. For example, people who don't have access to grocery stores with healthy foods are less likely to have good nutrition. That raises their risk of health conditions like heart disease, diabetes, and obesity — and even lowers life expectancy relative to people who do have access to healthy foods.” It additionally warns that, “Just promoting healthy choices won't eliminate these and other health disparities. Instead, public health organizations and their partners in sectors like education, transportation, and housing need to take action to improve the conditions in people's environments.”

Luckily for Western North Carolina (along with two other test regions of the state), that’s exactly what the NC Healthy Opportunities Pilot (HOP) - an innovative program designed to improve health outcomes for eligible Medicaid members by implementing critical evidence-based SDOH interventions - is attempting to accomplish. And to judge from recent reports, the program is producing some very real and tangible successes.

Using Medicaid Funds to Improve Health Outcomes and Reduce Costs in NC by Addressing Social Determinants of Health

Launched in 2021, HOP “is a cross-sectoral program providing 29 evidence-based services to address social needs related to housing, food, transportation, interpersonal violence, and toxic stress through networks of community-based organizations (CBOs) to eligible Medicaid enrollees in three regions of the state.” (via the Milbank Fund, Sept. 18, 2023).


As another recent article published in STAT News reports, “the Healthy Opportunities Pilot (HOP), is the first of its kind in the United States. With $650 million in federal funding secured in 2018, HOP aims to comprehensively test and evaluate how addressing the social determinants of health — access to healthy food, transportation, safe and clean housing, and interpersonal safety — can improve health outcomes, all the while reducing health care utilization rates and emergency services for Medicaid members. “ 

WNC’s HOP (overseen and managed by Impact Health, headquartered in Asheville, NC) covers the 18 westernmost counties of NC and the Qualla Boundary, and includes 54 nonprofit organizations providing a wide range of services. These include assistance such as home deliveries of fresh produce and healthy foods to eligible members struggling with food insecurity or dealing with nutritionally-impacted conditions like diabetes and heart disease; repairs and upgrades to substandard or dangerous living conditions to address concerns like mold, old carpeting, and poor insulation (which can exacerbate asthma and other health conditions) and structural issues that put inhabitants at risk; addressing root causes of health-damaging toxic stress; helping to secure transportation for non-medical health-related needs such as going to the grocery store, work, or school; and helping those dealing with interpersonal violence to find safety. 

And the results are promising. Among other successes, STAT reports that “So far, early results from the pilot suggest that food delivery programs associated with HOP are more effective in providing food security than those provided by food subsidies, like food stamps.” And William Blesser, research director at the Margolis Center for Health Policy at Duke University, additionally notes in the Harvard article that the structure and reach of North Carolina’s HOP is unique in several ways. “A lot of states are watching North Carolina,” Blesser says, “…and other states are even proposing to do something similar.”

HOP In The News…

To learn more about how the NC Healthy Opportunities Pilot operates, the impact it’s having on at-risk residents in our communities right now, and what the future holds in terms of new services, expanded reach, and other program goals, check out these articles:

For more information on NC HOP - what it is, how to connect with programs and service, and what we’ve learned from the pilot so far - explore these additional resources:

Soni Pitts
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