Headline
North Carolina Medicaid’s Healthy Opportunities Pilot (HOP) shows reductions in emergency department (ED) visits and overall health care costs.
Background
HOP, launched in March 2022 as part of North Carolina’s 1115 Medicaid demonstration waiver, represents a promising approach to address health-related social needs (HRSN) directly through Medicaid-covered services. Services designed to address needs in four domains — food insecurity, housing instability, transportation insecurity, and interpersonal violence/toxic stress — are provided through regional networks of community-based organizations, with eligibility limited to Medicaid members with qualifying physical health conditions, such as multiple chronic conditions or frequent ED use, and social risk factors. This study analyzed data from an interim evaluation of HOP, examining its initial impact on overall cost of care and health care utilization.
Findings
As of November 2023, over 198,000 pilot services had been provided to over 13,000 individuals, with 75% of services initiated within two weeks of social needs screening. Food assistance accounted for 86% of all services delivered, with 93% of individuals with food needs receiving support. Additionally, 68% of individuals with housing needs received housing services, 24% of those needing transportation received support, and 21% of those facing toxic stress or interpersonal violence accessed related services.
When compared to Medicaid members with documented social needs living outside of pilot regions, the program reduced average ED visits by six per 1,000 participants per month on average, with a greater reduction of 22 visits among those in the program for at least 12 months. Non-pregnant adults experienced two fewer hospital admissions per 1,000 participant-months. Additionally, overall health care costs dropped by $85 per participant per month.
Policy/Program Takeaways
The HOP interim evaluation provides compelling evidence that addressing HRSN through Medicaid can reduce emergency department utilization and health care costs while meeting participants’ social needs. These findings have significant implications for state Medicaid agencies designing HRSN initiatives, and other health care stakeholders seeking to improve health outcomes while reducing overall costs.