The Healthy Opportunities Pilot (HOP) is the nation’s first Medicaid initiative to pay for a comprehensive set of evidence-based services that address the root causes of health—like access to nutritious food, safe housing, and healthy relationships. The program’s goal is to improve wellbeing while reducing the need for costly medical care. An independent evaluation showed HOP reduced healthcare costs by an average of $164 per member per month by reducing emergency department visits and hospitalizations and increasing preventive care.
HOP services were suspended in July 2025 after the General Assembly did not include funding in their budget proposals. In July 2026, the state budget restored support for the program, allocating $9 million in state funds, which will be paired with $16 million in federal Medicaid dollars, to restart services.
The North Carolina Department of Health and Human Services is now redesigning HOP to align with available resources and updated waiver requirements. We are awaiting state guidance on when the program will relaunch and what the new service model will include.
A list of current resources is available here.
HOP impact in WNC from March 2022 to December 2025.
HOP participants served
of HOP participants are children
HOP services provided
community-based organizations in HOP network
Get a mother’s perspective on how HOP serves the Western North Carolina community.
