NC Healthy Opportunities Program helped reduce Medicaid costs

CHAPEL HILL, N.C. – A state-run pilot program aimed at helping North Carolina Medicaid recipients address their health-related social needs, such as food insecurity and housing instability, led to less spending over time compared to what would have been expected otherwise.

That’s the conclusion of an evaluation led by Seth A. Berkowitz, MD, MPH, associate professor and section chief for research in the division of general medicine and epidemiology in the UNC School of Medicine. These findings were published recently in the Journal of the American Medical Association.

“What I think is exciting about the findings is that they support the underlying idea of the Healthy Opportunities Pilots — that by addressing health-related social needs, the Medicaid program can improve the health of its beneficiaries,” Berkowitz said.

The Healthy Opportunities Pilots (HOP) of the North Carolina Department of Health and Human Services (NCDHHS) is the nation’s first comprehensive program to test and evaluate the impact of providing select evidence-based, non-medical interventions related to housing, food, transportation and interpersonal safety and toxic stress to high-needs Medicaid enrollees. The federal government has authorized up to $650 million in Medicaid funding for the Pilots over five years.

In their evaluation, Berkowitz and his study co-authors analyzed North Carolina Medicaid data from March 2021 through November 2023. They compared 13,227 HOP enrollees with 73,469 Medicaid recipients who reported having a health-related social need but were not eligible for HOP due to their county of residence.

Spending for HOP participants increased initially during the first month of enrollment, which may have been related to the reasons people enrolled in HOP in the first place, but over time spending trended downward by an average of $85 per beneficiary per month. After approximately 8 months of enrollment in HOP, monthly spending was about what it would have been in the absence of HOP, with lower spending thereafter.

Berkowitz is lead author of the JAMA article. Co-authors are Jessica Archibald, MSA; Zhitong Yu, MPH; Myklynn LaPoint, BA; Salma Ali, MPH; Maihan B. Vu, DrPH, MPH; Gaurav Dave, MBBS, DrPH, MPH; Kori B. Flower, MD, MS, MPH; and Marisa Elena Domino, PhD. All of the authors are affiliated with UNC except for Domino, who is affiliated with Arizona State University.

About UNC School of Medicine

The UNC School of Medicine (SOM) is the state’s largest medical school, graduating more than 200 new physicians each year. Its faculty includes 21 members of the national academies and two Nobel laureates. The UNC School of Medicine receives more than $648 million in research funding annually. It has more than 2,000 total students, and its alumni go into health careers with less student loan debt than many of their peers across the country.

About UNC Health

UNC Health is a state entity and an affiliated enterprise of the University of North Carolina system, comprised of nearly 20 hospitals and more than 900 clinics along with the clinical patient care programs of the UNC School of Medicine (SOM). It exists to improve the health and well-being of North Carolinians and others we serve and to further the teaching mission of the University of North Carolina SOM. UNC Health provided more than $800 million in Uncompensated Charity Care during the past five years. Our hospitals have received numerous awards and recognition for quality care, patient safety, and the overall patient experience.