The Healthy Opportunities Pilot (HOP) is an innovative Medicaid initiative designed to improve health outcomes by addressing the nonmedical drivers of health. While most healthcare spending focuses on clinical care, the majority of what shapes a person’s health happens outside the doctor’s office.
Under the first Medicaid demonstration waiver, HOP used Medicaid funds to pay for evidence‑based services that support access to nutritious food, safe and stable housing, reliable transportation, and interpersonal safety.
HOP services were paused in July 2025. Funding for HOP to operate under a new waiver was restored a year later and includes $9 million in state funding approved by the North Carolina General Assembly in July 2026, paired with $16 million in federal matching funds.
The North Carolina Department of Health and Human Services (NCDHHS) anticipates HOP will restart in early 2027 with the following changes.
The revised pilot will focus on one high-impact service: home-delivered healthy food boxes. Eligibility will be limited to Medicaid members who are pregnant or who have diabetes and/or cardiovascular disease. These services are expected to run through June 2027.
HOP has a track record of expanding access to healthy opportunities in WNC.
Findings from the first demonstration waiver show that HOP services improve participants’ health, reduce emergency department visits and hospital stays, and save an average of $164 per participant each month. Beyond individual outcomes, HOP strengthens rural economies, supports local farms and businesses, builds community infrastructure, and helps people return to school, work, and community life.
