Sarah Ridout is the HOP Director with Community Care of the Lower Cape Fear. She said that providing these services, on average, saves Medicaid $85 a month per member because, as the UNC report showed, members are less likely to visit the emergency department. In 2024, for Cape Fear HOP, that meant a yearly savings of up to $1.4 million.
Ridout said they believe this savings figure is “very, very conservative.”
Related: Healthy Opportunities Pilot shows cost savings for Medicaid: “It’s a hand up”
The HOP program is available only to some Medicaid recipients who qualify. The program's framework allows 46 Health Service Organizations (HSOs) in the Cape Fear region to get reimbursements for their services. The most common service is healthy food boxes, but providers also help with things like financial support for rent and utilities and counseling for toxic stress, typically measured by the Adverse Childhood Experiences (ACE) score.
According to Jay Ludlam, North Carolina’s deputy secretary of NC Medicaid, the “best way to lower healthcare costs is to reduce the demand.” HOP does this by going downstream of problems with members to do those “non-medical” interventions of providing healthy food, access to safe and affordable housing, and counseling for toxic stress. Ludlam reiterates that HOP members are healthier people who don’t need to access the emergency department as much as they did before receiving those services.
Ludlam also said that because of this support network, communities are seeing local job growth regarding the farmers who support the food box and home-repair businesses. HOP can cover expenses like mold remediation and support bars in bathrooms and along stairs. In 2024, Cape Fear HOP reported that over 250 jobs were created because of the program.
Since the pilot’s inception in 2018, Cape Fear HOP has also provided 1,700 people with their first month's rent and security deposit, and from initial data, most of those people have been able to stay in those homes. That stability likely comes from these HOP members working with a housing case manager who then develops a plan to analyze the person’s income and expenses to determine what they can afford over the long term.
While state and federal dollars support HOP, there are questions about the new political climate under the Trump administration. Ridout said that the pilot started in the 2016 Trump administration and was overseen by the Biden administration. She noted the continuation of the multimillion-dollar HOP pilot is in Democratic Governor Josh Stein’s 2025-2027 budget, although the state House and Senate, both controlled by Republicans, have yet to release their budgets. The House is set to post their budget on April 14 at 5 p.m.
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