NCDHHS launched the Healthy Opportunities Pilots (HOP) in 2022 to provide help for people enrolled in Medicaid who had both a qualifying social risk factor—such as unstable housing, transportation barriers, interpersonal safety challenges, toxic stress, or food insecurity—and a qualifying physical or behavioral health condition.

HOP moved beyond addressing immediate health needs and took a holistic approach to improve health outcomes by providing housing stipends, access to a choice of nutritious food options, interpersonal violence interventions, and more.

“Something that can seem small, like receiving a food box, can have a huge positive impact on a household’s stability,” said Maria Ramirez Perez, associate director of Healthy Opportunities.

NCDHHS partnered with community-based organizations to guide and provide HOP services to ensure they were reflective of community needs. Through feedback and evaluation, HOP evolved to better serve enrollees.

“Some of it is sitting in a room with community-based organizations, saying we are here to work together, and recognizing that everyone in that room brings their own much-needed experiences and expertise,” said Perez.

HOP strengthened the local economy by leveraging community organizations and local resources. An independent evaluation determined that HOP participation resulted in an $85 per-person-per-month reduction in healthcare costs. As of July 2025, HOP served more than 40,000 Medicaid enrollees, but an absence of state dollars has halted the program.