A bipartisan health care affordability pilot in North Carolina actually worked | STAT

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OpinionFirst Opinion

We proved bipartisan health care reform works in North Carolina. Let’s bring it nationwide

Our comprehensive pilot using Medicaid funding for targeted, evidence-based social services was a success

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Charlotte, N.C.Adobe

By Mandy Cohen and Kody Kinsley<br>Aug. 17, 2026

Cohen served as North Carolina’s secretary of health and human services from 2017 to 2022 and director of the CDC from 2023 to 2025. Kinsley served as North Carolina’s secretary of health and human services from 2022 to 2025.

America’s health care affordability crisis is not a partisan problem. It is bankrupting families, straining state budgets, and overwhelming emergency rooms from rural Appalachia to downtown Seattle.

While it is not a cure-all, we want to share something that worked in the purple state of North Carolina, in some of the most underserved rural communities in America, built with support from both sides of the aisle. We call it the Healthy Opportunities Pilots, and the results recently came in. They are worth everyone’s attention.<br>Advertisement

The premise is straightforward: What if Medicaid could help pay for healthy food, housing, or transportation to a doctor’s appointment to keep people healthy and out of expensive care settings like emergency rooms and hospitals? Decades of research has told us that social factors drive a staggering share of health outcomes and cost.

In 2018, at the beginning of Gov. Roy Cooper’s administration, we worked with the first Trump administration and North Carolina’s Republican-controlled state legislature to build the nation’s first comprehensive pilot to test using Medicaid funding for targeted, evidence-based social services.

Building it was hard. We designed new contracting mechanisms, recruited community organizations that had never worked directly with Medicaid, built a statewide technology platform, and trained thousands of frontline workers — all in rural communities where trust in government had worn thin.<br>Advertisement

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A rigorous multiyear evaluation by the University of North Carolina Sheps Center for Health Services Research is now complete, covering more than 31,000 enrollees from program launch in 2022 through late 2024. The headline: Medicaid saved an average of $164 per person per month, after accounting for the cost of every service delivered and every dollar of overhead. Savings were not immediate; they built over time, just as we expected. But by the final period of measurement, they were substantial and statistically significant.

We got there by shifting care out of the emergency department and into the community. HOP participants had significantly fewer emergency department visits and hospital admissions, more outpatient provider contact, and real reductions in food insecurity, housing instability, and transportation barriers. Nearly 90% of participants reported that HOP improved their health and the health of their children.

The results are not a rounding error. At scale, $164 per member per month represents billions of dollars in potential savings for state and federal Medicaid budgets while simultaneously improving people’s lives.

Politically, North Carolina is a closely divided state. We worked for Cooper, a Democrat, and our state legislature has been Republican-led for decades. So how did we build and sustain this program across the aisle? We aligned on the shared goal of fiscal stewardship and grounded the work in community. Conservative and progressive legislators alike care about whether taxpayer dollars are being spent wisely. And rural North Carolina has a proud tradition of neighbors taking care of neighbors. HOP was built through local nonprofits, faith communities, and health organizations that already...