Investing in a Healthier North Carolina: Lessons Learned from North Carolina Medicaid Reforms

Over the last decade, North Carolina Medicaid has made significant strides in building a more coordinated, whole-person system of care by prioritizing initiatives focused on “investing in health”. With delays and shortfalls in the state budget, as well as impending federal policy changes and funding cuts due to House Resolution 1 (enacted by the 119th Congress in 2025), the future of these initiatives is uncertain. This is particularly evident for one key initiative, the Healthy Opportunities Pilots (HOP) program, which aims to address upstream drivers of health such as food and housing insecurity by providing evidence-based, non-medical services to high-needs Medicaid members. Service delivery through HOP has been paused since July 1, 2025, due to the absence of available state funding. These developments raise urgent questions about how the state can continue its progress to improve health outcomes and reduce costs.

North Carolina has continued to set goals to improve the health and well-being of North Carolinians as part of Healthy North Carolina, a decades-old initiative that outlines key health indicators with 10-year targets to guide state initiatives. The goals of HOP closely align with the priorities of “Healthy North Carolina 2030,” with a focus on addressing upstream drivers of health in the social, economic, and physical environments to improve health outcomes. As the futures of HOP and other Medicaid reforms are being considered, we reflect on why these programs have worked well in North Carolina and how these lessons can help chart a path forward to continue to improve health for North Carolinians.

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Learn more about Duke-Margolis' research on the Healthy Opportunities Pilots program here.