Map of NC counties participating in the Healthy Opportunities Pilot. (Source: NC DHHS)
North Carolina launched a program called Healthy Opportunities in 2022 in three mostly-rural regions of the state to see if providing food, transportation, housing, and other non-medical health-related needs for people who use Medicaid as their insurance would improve their physical health.
The federal government, which approved the Healthy Opportunities Pilot during President Donald Trump’s first administration, has given the state the green light to expand statewide.
“Too often non-medical factors like lack of access to healthy foods or inability to get to an in-person appointment seem to stand in the way of disease prevention and better primary care,” said Dr. Mark McClellan, director of the Duke-Margolis Institute for Health Policy. “This pilot has aimed to develop the infrastructure needed to enable these kinds of non-medical factors to be addressed, when they can help lower overall costs and improve health.”
The state Department of Health and Human Services is hoping the legislature will support Healthy Opportunities’ expansion.
With budget season underway, Duke-Margolis hosted a video roundtable on the Health Opportunities Pilot where participants extolled the program not only for improving health, but for helping people recover from Helene, supporting small and medium-sized farms, and helping to reduce health care provider burnout.
“The question is, because of all the success we have had, how can North Carolina not afford to scale statewide?” said former DHHS secretary Kody Kinsley.
“We’ve got to continue to push forward because we need to control costs of health care broadly and upstream prevention is the clear answer,” he said. “It’s the win-win in driving down costs and improving health.”
The Centers for Medicare & Medicaid Services (CMS), the federal office that oversees Medicaid, published an interim evaluation of Healthy Opportunities in November 2024. It said 11,809 people received the program’s services between March 2022 and November 2023.
Dr. Seth Berkowitz, an associate professor at the UNC School of Medicine, is leading the formal CMS evaluation.
“We found that the program reduces health-related social needs, so we see less food insecurity, less housing instability, things like that, when people participate in the program,” he said.
The analysis reported a decline in emergency room visits that may be attributable to Healthy Opportunities. It estimated a statistically significant reduction in hospital admissions for adults. However, the estimated reductions in hospital admissions for pregnant individuals, and children and teenagers were not statistically significant. Hospital admissions for children three years old and younger were estimated to have increased.
Considering health care costs in the 12 months before and the 12 months after enrollment in Healthy Opportunities, health care savings attributable to the program were $85 per person per month, according to the evaluation.
The savings are coming from better health, not denying services, Berkowitz said.
“People still have access to all the same health care they’ve had before,” he said. “A change in spending is really a strong indicator that people’s health is improving and that is why we’re seeing the need for health care spending go down.”