RALEIGH, N.C. — A North Carolina Medicaid pilot will not receive approval from the state House necessary to continue the program.

This program is called the Healthy Opportunities Pilot. State senators approved $30 million in stopgap funding for the program on Tuesday, as part of a greater bill for a continuation of funds for many measures, to keep it operational. However, HB 125 was not listed on any agenda for a vote by the House.

House Speaker Destin Hall spoke about the program on the floor after Wednesday's session.

“First thing, I would say from our side that it’s really not clear that any folks are benefiting from that program," Hall said.

However, an interim independent evaluation showed some good had come from it. The North Carolina Department of Health and Humans Services commissioned the Cecil G. Sheps Center for Health Services Research at the University of North Carolina to conduct a review.

The summary found that HOP participation was estimated to reduce six visits to the emergency department per 1,000 members a month.

Still, the speaker said committee chairs in the House are taking a close look at the money designated for the program to ensure it is being used for the intended services. 

"To make sure the funding going to it is actually going to help folks or are we doubling up efforts with expansion and that program? Long story short, no I don’t see that as a big problem for us having to get done July 1 even if we keep some form of that program," Hall said.

The measure, commonly known as HOP, is an innovative approach to health care that “buys health” for members of the program, according to the Department of Health and Human Services.

The pilot administrators, called network leads, are spread out across the state, with two in the east and another in the west. Underneath network leads are the home service organizations. 

It is through those organizations that services flow.

The program is designed to offer members a variety of services, including farm fresh food, home repairs, rides to appointments, even safety from interpersonal violence.

One beneficiary in Winterville said her life would be upside down without the program.

“It's not fast food. It’s not McDonald's. It’s not Wendy's. It’s not Taco Bell,” Evette said.

For confidentiality, Evette asked not to disclose her last name. 

She has two children who receive Medicaid, which qualified her family for the Healthy Opportunities Pilot.

The mother has received a food box packed with fresh fruits and vegetables every week.

“This program really does help,” she said.

The program took off in 2022 with federal support. 

A waiver gave North Carolina the freedom to use $650 million in Medicaid funding to pay for non-medical services with the goal of lowering stress over money.

The concept is to improve a person's health by increasing access to community resources without billing Medicaid for expensive medical treatments. 

Evette said she had a rough time getting by before she joined the program last fall.

“I was struggling paycheck to paycheck,” she said.

It’s a struggle she worried will return. 

If more money is not added for the program to the budget by this fall, Deputy Secretary for N.C. Medicaid Jay Ludlam said that would be a death sentence.

“Without the General Assembly appropriating that, for now, we will have to stop the program,” Ludlam said.

Previously, the state health agency warned of the abrupt stop in operations across the constellation of providers by July 1.

Partners like the Catholic Charities of the Diocese of Raleigh in Greenville sign up as home service organizations. Catholic Charities delivers food boxes to members like Evette.

The Catholic Charities falls under Access East, a network lead that covers services for Beaufort, Bertie, Chowan, Edgecombe, Halifax, Hertford, Martin, Northampton and Pitt counties.

The Community Care of the Lower Cape Fear has 41 home service organizations in its coverage area. 

Sarah Ridout is the program director for the Cape Fear Healthy Opportunities Pilot.   

“We are seeing a reduction in emergency department utilizations as well as a reduction in hospital admissions,” Ridout said.

That was one of the goals when the program was created.

An Asheville-based nonprofit, Impact Health, is also part of the Healthy Opportunities Pilot as a network lead. 

Laurie Stradley is the program director of Impact Health who said the Healthy Opportunities Pilot funding made it easier to quickly provide healthy meals to families in need after Hurricane Helene.

“It was just click, click, click and it was just incredible to see that come together,” Stradley said.

Since the expansion of the Healthy Opportunities Pilot, community partners have hired more employees. Kevion Dixon is one of them at Catholic Charities. 

“I love people. I love helping people,” Dixon said. Dixon is the food delivery program manager for the organization. “(I love) getting up every day, being driven to just help those around me. That's why I wanted to be here.”

The community partner houses sliced carrots, oatmeal, bagged goods, seasonal crops and cultural ingredients for dishes like tortilla wraps.

After a box is packed for a member, Dixon or one of his employees will drive nutritious food to hungry families from as north as the Virginia state line to deep in rural eastern North Carolina.

“They’re just looking to make it day-to-day,” Dixon said.

The funding debate is based on the return on investment.

A Centers for Medicare and Medicaid analysis found cost savings of about $85 a month for each person in the program from mid-March 2022 to the end of November 2023. The savings roughly equate to a little more than $1,000 a year for each person. At the time this federal report was released to the public, 11,809 people had received services. 

For Evette, it’s make or break. 

“Oh, I would say I'm saving, like, at least $200 a month. When the program leaves, I'm going to be back to crunching the numbers,” Evette said.

An evaluation of the program last year also found that it hospital stays by a small margin.