New Study Highlights Role of NC Healthy Opportunities Pilot in Reducing Medicaid Cost and Improving Health Outcomes
Photo by Sasirin Pamai
A new study recently published in the Journal of the American Medical Association demonstrates that Medicaid beneficiaries enrolled in NC’s Healthy Opportunities Pilot (HOP) showed an overall decrease in Medicaid spending compared to non-HOP enrollees, as well as other indicators that correlate to improved health outcomes.
HOP Generates $85 Per Person/Per Month Reduction In Medicaid Spending Among HOP Participants
On Feb 27, 2025, the Journal of the American Medical Association published Medicaid Spending and Health-Related Social Needs in the North Carolina Healthy Opportunities Pilots Program. In this study, authors Seth A. Berkowitz, Jessica Archibald, Zhitong Yu, et al, used a “[c]omparative interrupted time series evaluation using North Carolina Medicaid data from March 2021 through November 2023,” to compare 13,227 HOP enrollees with 73,469 Medicaid beneficiaries who had reported a HOP-eligible health-related social need, but “who were ineligible for HOP due to county of residence.”
The study specifically looked at “the sum of spending by Medicaid on medical and HOP services per beneficiary per month,” as well as health care use such as emergency department visits, inpatient admissions, and outpatient visits.
Overall, the study found that while Medicaid spending increased in the month of HOP enrollment, it then decreased over time to −$85 per beneficiary per month, a substantial return on investment. For context, a program or pilot that achieves $5-$10 pm/pm savings is typically considered “incredible,” according to comments from Maria Ramirez-Perez, Associate Director of Healthy Opportunities, NC Dept. of Health and Human Services during a previous WNC HPI presentation.
The study also found lower utilization of emergency room services among HOP participants, a finding that indicates improved health outcomes through program-related outcomes such as improved living conditions, reduced toxic stress, improved nutrition, and increased access to transportation to attend to health care needs.
From the paper’s abstract:
The comparative interrupted time series analysis estimated that spending increased at the month of HOP enrollment (change in level, $687; 95% CI, $420-$954). However, the trend in spending for HOP participants was differentially lower (change in trend, −$85 per beneficiary per month; 95% CI, −$122 to −$48; P < .001) relative to a counterfactual scenario without HOP. Taken together, these findings indicated that monthly spending was equivalent to estimated counterfactual expenditures by month 8 after starting HOP and lower thereafter. Emergency department visit trend was differentially lower for HOP participants (−6 per 1000 person-months; 95% CI, −8 to −4). There was no statistically significant differential trend in hospitalizations (−1 per 1000 person-months; 95% CI, −2 to 0) or outpatient visits (1 per 1000 person-months; 95% CI, −7 to 9).
Overall, the findings are clear: NC’s Healthy Opportunities Pilot is proving to be a successful model for reducing healthcare costs and improving health outcomes for participating Medicaid beneficiaries. This in turn can help to reduce strain and utilization of our already over-burdened health care systems, build stronger, more resilient communities, and provide greater opportunities for beneficiaries and their families to participate as productive members of those communities by supporting greater financial stability and function capacity, a longer lifespan/healthspan, and improved overall quality of life.
Learn More
To learn more about the NC Healthy Opportunities Pilot and WNC’s HOP, which is serving as a model for HOP programs both within and outside of our state, check out the resources below:
Healthy Opportunities Pilot Resources
NC Department of Health and Human Services Healthy Opportunities Pilot information Page
NCDHHS’ Healthy Opportunities Pilots Interim Evaluation Report Summary (published 4.4.24)
Impact Health (Network Lead for the WNC Healthy Opportunities Pilot)
HPI Blog Posts & Podcast:
In The News: NC Medicaid’s Healthy Opportunities Pilot (10/6/23)
