The program, started in 2018, has shown promising results and garnered bipartisan support. According to Ludlam, HOP is really about recognizing that much of a person’s health depends on where they live and the conditions in which they live. HOP was meant to improve those conditions through access to healthy foods and consulting services to help people deal with issues around housing, transportation, and interpersonal violence.
One of the main goals of HOP, operating in 33 counties around the state, was to test whether providing financial support for these services would reduce healthcare costs. Ludlam said an independent evaluation of the program found that to be the case.
“People go to the emergency room less often. They stay in the hospitals for fewer days after a surgery, and because of that, the net effect to the state is we actually save money. We reduce costs to the Medicaid program because people are less sick and are getting those services within their community,” he said.
This evaluation, mainly conducted by researchers at UNC Chapel Hill, found savings of around $1,000 per year per enrollee.
Ludlam said it’s a difficult year for the budget as state revenues are down. He said he remains hopeful that HOP funding might make its way back into the final state budget, but that because service providers often need 30-day lead times, and there’s no funding as of right now, he had to effectively stop the HOP pilot.
“Am I hopeful? Of course, I am. But as a Medicaid director, we're responsible for operating within the budget that was given, and therefore we had to make that difficult decision to stop services on July 1,” he said.
HOP is in Governor Josh Stein’s budget for $87 million. Ludlam said if that amount makes it into the state budget, they would get additional federal funding to bring the HOP total funding to $300 million over the next fiscal year.
Senate Majority Leader Michael Lee, who represents New Hanover County and chairs the committee on appropriations/base budget, has praised the program for its cost savings. When asked if he was concerned about the program's cut, he wrote in an email, “It is a non-recurring program since it is a pilot program. As such, it is not a cut. However, since the funding runs out, I am advocating for extending the HOP program in the pilot counties and then studying expansion in the state.”
Other Republican politicians, like Pender County Commissioner Jimmy Tate, have joined Lee in supporting the program. Tate even credited Lee with saving the pilot in prior budget years.
If the HOP program ends, 46 community organizations in the eastern region that support Medicaid recipients will be impacted. The service providers will no longer be able to serve clients because they can no longer get reimbursements from HOP.
Sarah Ridout is the program director for the Cape Fear Healthy Opportunities Pilot.
She sent an emailed statement saying that she was concerned about the negative impact of the program’s end not only on the Cape Fear region but also on the other counties around the state, particularly those in western North Carolina. However, like Ludlam, she is optimistic that the General Assembly can reinstate the provision during budget negotiations.
But Ridout did warn about the damage being done to the community now, the freezing of enrollment, and the impending stop of services on July 1.
“Some of our most vulnerable citizens with chronic health conditions are no longer receiving the non-medical interventions shown to improve health outcomes, including reduction in demand for Emergency Department and Hospital visits. Unfortunately, the abrupt stop is already causing tremendous harm to individuals experiencing violence in the home, children out of school for the summer with limited food, and those almost safely housed. Economically, the region is trying to embrace for the impact of job losses, reduced reliance on farmers, local contractors, and local businesses,” she wrote.
Ludlam had to put a pin in the program expansion his office was planning.
“We're getting ready to bring it to the Eastern Band of Cherokee Indians, as well as with the new children and family specialty health plan that was going to be launched, or is going to be launched, in December of this year. And so those were our plans and the populations we're bringing in. So this program was growing over time,” he said.
Ludlam has been in Medicaid services for about 18 years. He started in Missouri and ended up in North Carolina eight years ago.
“This is one of the most successful programs I've seen in terms of how it improves health and reduces costs. [...] We have had a large number of states have begun to replicate and copy North Carolina and the way we do it because we do it right. We do it in predominantly rural counties. We do it in a way that brings the strength of the local community to identify and see where the need is, and who can best support [them].”
Prior reporting
- Cape Fear leaders talk about policies that affect social determinants of health
- Unpacking NC Project LEAD’s policy forum, and legislative efforts to fund free school meals
- Healthy Opportunities Pilot shows cost savings for Medicaid: “It’s a hand up”
- Study shows Cape Fear Healthy Opportunities Pilot saves Medicaid money
