North Carolina’s bipartisan Medicaid pilot proves social supports save money and improve health

North Carolina's Healthy Opportunities Pilots (HOP) used Medicaid funding to cover nonmedical services such as food, housing, and transportation in rural areas and, per UNC Sheps Center evaluation of 31,000 enrollees (2022–2024), saved an average of $164 per member per month after accounting for costs, by shifting care away from emergency departments to community supports. HOP participants saw fewer ER visits and hospitalizations, more outpatient contact, and reductions in food insecurity, housing instability, and transportation barriers, with about 90% reporting health improvements. Built through cross‑aisle cooperation and local trusted organizations, the program is being continued and scaled in North Carolina, with calls for Congress to enable similar Medicaid social‑service integrations and for CMS to expand waivers; the authors argue pragmatism and real‑world evidence can beat partisanship and merit replication.