North Carolina’s Healthy Opportunities Pilot (HOP) program is expected to return to the Cape Fear region soon, though officials can’t yet say exactly what it will look like. 

In July, the General Assembly passed its most recent budget, allocating about $9 million to HOP for the fiscal year and leveraging about $16 million in federal funding from the Centers for Medicare & Medicaid Services (CMS). The program was previously paused last year after the state’s mini budget fell short of the N.C. Department of Health and Human Services' (NCDHHS) projected needs. 

With the program funded again, HOP is expected to start offering services, though network leads are waiting on NCDHHS to determine which services will be greenlit again.

Sarah Ridout, director of community programs at Community Care of the Lower Cape Fear (CCLCF) and HOP program director for the Cape Fear region, anticipates HOP services will be more limited over the next year. 

“I do think we will see a more limited framework, given the funding that is available,” Ridout said. “We had HOP with 28 active services in food, housing, transportation and IPV toxic stress.”  

While the program was active from 2022 through 2024, over 31,000 people had enrolled in HOP across three regions in the state, including CCLCF’s six counties.

Ridout added that CMS moved to remove transportation as an authorized service from the program. According to the program’s updated waiver, transportation may be allowed for transport to and from HOP services and for non-emergency medical transportation to and from HOP services.

“Transportation is really important in our region and in our rural communities,” Ridout said. “So, as we are building up and lifting up this work regionally, we would like to continue to see support in transportation, non-medical transportation.” 

While transportation was among the top HOP services in demand in the Cape Fear region, along with food access and housing, Ridout added that the program helped prove that a holistic approach to health had major cost benefits. Additionally, a study by the Cecil G. Sheps Center for Health Services Research at UNC-Chapel Hill found that the program reduced healthcare costs by about $164 per participant each month.

“There wasn’t one service that outshined the other,” Ridout said. “This is an opportunity to help support people in the way where it is not a handout; it is a hand into living more independently and more sustainably moving forward.”

HOP was authorized under an 1115 Medicaid Waiver, allowing the NCDHHS to use $650 million in Medicaid funding for the program through 2029. The program is designed to improve health outcomes and reduce healthcare costs by addressing social determinants of health through non-medical, evidence-based “interventions,” like rent or utility assistance, mold remediation or a health food box, for example.

The program has operated in three regions: western North Carolina, northeast North Carolina and the lower Cape Fear region, overseen by CCLCF. While HOP was active, CCLCF provided over 400,000 services in its six-county region alone. 

Although the program may wind down in 2029 if not renewed, Ridout noted that HOP was never intended to continue indefinitely. 

“The goal really was not to have HOP as it stands to go forward forever,” she said. “It was really ‘what are those interventions that we see are budget neutral or high value, but also have those impacts in place, whether it is a health outcome, a healthcare cost, a utilization shift … and then implement them and embed them into Medicaid, even beyond Medicaid.”

Ridout added, “We’ve seen in the summative evaluation that somebody receiving these types of services could have around $1,900 worth of cost savings. That can translate beyond Medicaid … to a commercial payer … to somebody in Medicare.”

Using lessons learned during CCLCF’s participation in HOP, the organization is taking a swing at its own social care hub. With around $4 million in grants from the New Hanover Community Endowment, CCLCF is building the groundwork for how the hub will operate. 

“What we’re trying to achieve now as Community Care of the Lower Cape Fear is to take what we’ve learned, take those outcomes, and build an infrastructure in this region that is durable, and that takes the learnings from Healthy Opportunities and creates a true care hub infrastructure in our region,” Ridout said. 

Ridout’s goal for the hub is to follow a payer-diversified model, allowing partners to “plug in” to the hub with an identified population to serve and specific interventions to target. Those partners could include hospitals, health plans, employers, foundations and local governments, and vetted community-based organizations would deliver services within the network. 

“The goal of our model … is to really try to work locally and reinvest locally back into our community," Ridout said. 

The organization is focused on building out testing workflows and technology infrastructure to support the hub, Ridout said. It completed a “mini pilot” this summer with around 85 community members and two interventions, including pairing a healthy food box with nutrition education and housing navigation. 

“HOP has given us a huge opportunity, not just here in the state of North Carolina, but across the nation,” Ridout said. 

She added, “The learnings are really integral to other states also building out care hub models that are durable and sustainable.”