Community Voices from North Carolina’s Healthy Opportunities Pilots Program: Implications for Designing and Evaluating Programs to Address Upstream Drivers of Health

Copublished with the Duke-Margolis Center for Health Policy

Abstract

North Carolina’s Healthy Opportunities Pilots (HOP) program, which was paused in July 2025 due to state funding constraints, tested whether providing evidence-based services to address upstream drivers of health for eligible Medicaid members could improve health outcomes, reduce costs, and address disparities in three predominantly rural regions of the state. Summative program evaluation findings released in June 2026 estimated Medicaid savings of $164 per enrollee per month. Yet programs addressing upstream drivers of health often show benefits that extend beyond the health care utilization and cost metrics captured in traditional evaluations. Drawing on qualitative analysis of 270 stories collected between 2022 and 2025 — including stories from before and after the program pause — this report explores the experiences of people who participated in HOP, including enrollees, care managers, and staff at community-based organizations. The analysis finds that meeting people’s holistic needs can improve health and well-being — and have positive effects on their families, communities, and regional economies.