North Carolina
Opinion: NC’s HOP program has led to healthier residents, lower medical costs. It needs funding
The best way to lower health care costs is to reduce the need for expensive medical services by preventing illness in the first place. Thanks to the foresight of North Carolina lawmakers, our state tested a pilot program that does just that. In only two years, people are healthier and health care costs are lower. But despite its success, the future of the Healthy Opportunities Pilot is unclear.
As the two most recent secretaries of the North Carolina Department of Health and Human Services, we launched HOP by working with the Republican-led General Assembly and with the first Trump administration, which approved the pilot. North Carolina’s innovation has since become a model for other states and earned national attention for its impact.
HOP is based on a simple idea — it costs less to keep people healthy than to treat them after they get sick. We spend most of our money in this country treating diseases, rather than preventing them. Evidence from HOP has shown that investing in things that impact your health such as food and housing not only prevents disease but also saves money.
Recent studies show HOP reduces health care costs by $1,020 per participant each year. The savings come from people needing fewer trips to the emergency room and fewer hospital admissions. People are staying healthy because local farmers, nonprofits, and small businesses deliver meals so people have healthy food, make home repairs that get rid of mold and help avoid asthma attacks, and help patients get preventive care and medicine when they need it, not after it becomes an emergency.
In Western North Carolina, families displaced by Tropical Storm Helene faced similar challenges. One mother, whose child suffered from asthma, received support from HOP to make their new home safer by removing mold and other triggers through the Breathe Right program. The result? Fewer ER visits and a healthier future. In the Cape Fear region, a young single mother was struggling with unsafe housing, food insecurity, and her children’s health problems. With support from HOP — including help with housing, food access, and parenting resources — she found stability. She secured full-time work, moved her family into a safe home, and saw their health improve dramatically.
And yet, despite these successes, North Carolina lawmakers have not included specific funding for HOP in either the House or Senate budget proposals. Without funding, millions in federal dollars will be pulled out of our rural communities, emergency department and hospital visits will likely rise again, health care costs will increase, and people’s health will be at risk.
Cutting programs like HOP does not save money. It just shifts costs to emergency rooms, schools, and long-term care facilities — and drives up costs for all of us. It’s why lawmakers funded Healthy Opportunities in the first place. And now that it’s delivered on the promise of saving costs, it’s time to double down on what works. In December of last year, noting the proven success of HOP, the federal government approved expanding the pilots statewide, which could unlock amazing opportunities across all of North Carolina. As North Carolina faces tough budget choices, sustaining and growing programs like HOP is the fiscally responsible decision. It supports healthier families, stronger communities, and a more sustainable health care system.
With uncertainty at the federal level and no funding included for HOP in either the North Carolina House or Senate budgets, the program’s future hangs in the balance. If it ends, the consequences will be real — lives, jobs, and hurricane recovery efforts will all be at risk. In a time when so much feels uncertain, this is a solution we can agree on. The evidence is clear, the need is urgent, and the stakes are high. Our state must continue to lead the way with common-sense improvements to our health system.
The question is not how we can afford to do this; it is how we cannot?
Dr. Mandy Cohen and Kody Kinsley are former Secretaries, NC Department of Health and Human Services.