Opinion: We proved bipartisan health care reform works in North Carolina. Let’s bring it nationwide
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- North Carolina's Healthy Opportunities Pilots saved Medicaid an average of $164 per person per month after accounting for service costs and overhead, according to a University of North Carolina Sheps Center evaluation covering more than 31,000 enrollees from the 2022 launch through late 2024.
- The program was designed in 2018 with bipartisan backing from Democratic Gov. Roy Cooper, the first Trump administration, and North Carolina's Republican-controlled legislature to test using Medicaid dollars for evidence-based social services like healthy food, housing, and transportation.
- HOP participants had significantly fewer emergency department visits and hospital admissions, more outpatient provider contact, and nearly 90% reported the program improved their health and their family's health, alongside reductions in food insecurity, housing instability, and transportation barriers.
- Savings were not immediate but built gradually, becoming substantial and statistically significant only by the final measurement period — a timing detail the authors say policymakers should plan around when considering replication.
- North Carolina legislators voted in July to continue the program, which had been paused during the state's budget impasse the previous year, scaling access to the services driving the biggest savings.
- Former NC HHS secretaries Mandy Cohen and Kody Kinsley, who helped build HOP, are urging Congress to codify Medicaid pathways for evidence-based social services and asking CMS to expand guidance and waiver authority so states don't have to seek individual waivers.
Why it matters: At scale, the $164-per-member-per-month savings figure translates to billions in potential state and federal Medicaid savings while improving health outcomes, giving both parties a fiscally framed template rather than a partisan one. The July vote to revive the paused program also shows that even evidence-backed pilots can be politically fragile without federal codification.
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