North Carolina's Healthy Opportunities Pilots: Impacts and Budgetary Considerations

North Carolina’s Healthy Opportunities Pilots (Pilots) program is a promising model for continued bipartisan health care reform. The Pilots align with bipartisan state and federal priorities to make health care more prevention-oriented by improving health outcomes, chronic disease prevalence, and chronic disease complications by addressing their root causes. Addressing non-medical drivers of health can reduce longer-term Medicaid spending. In three years, the Pilots have generated evidence of cost savings (an estimated $1,020 per enrollee per year), with additional savings projected if the program were to continue to grow to additional populations and counties. Through the Pilots, North Carolina has the opportunity to leverage millions in federal support for advancing prevention to reduce its future Medicaid costs.

A core challenge is translating these prevention-oriented savings, which take time, into a short-term state budget cycle. Despite overall savings, the program’s cost-neutrality in two years cannot be assured; additional time is likely needed to realize significant savings from better prevention and chronic disease management. Nonetheless, the Pilots present a critical opportunity for North Carolina to continue to improve health, shift Medicaid spending toward prevention, and achieve longer-term savings for the state. The Pilots also have demonstrated value for improving the health, infrastructure and economies of North Carolina's communities, including rural communities and those most impacted by Hurricane Helene. Funding to continue, refine, and expand the Pilots would enable the state to build on this evidence and learning to further improve health and increase savings.

For more information about Duke-Margolis research on the Pilots, click here.