Medicaid beneficiary braces as pilot program shutters

A pilot program that provided non-medical financial aid to Medicaid recipients was effectively shuttered as the fiscal year ended Monday with little hope for future appropriations, raising concerns with a Greenville woman who benefited from the funds.

A North Carolina DHHS spokesman said the state's Healthy Opportunities Pilot, or HOP, program was the nation's first comprehensive program to test and evaluate the impact of select evidence-based, non-medical interventions for high-needs Medicaid enrollees. The services included housing and food assistance, transportation and support groups for parents who needed help with their children.

The program, which launched in 2022, served more than 43,000 North Carolinians in 33 counties, including Pitt, DHHS said. Services reduced visits to hospital emergency departments and reduced the cost of needed medical care for enrollees by more than $1,000 per person annually, the agency said.

However, the program has not been included in either the North Carolina House or North Carolina Senate's proposed budgets for the upcoming two years. Without funding as of Monday, the end of the fiscal year, the program effectively shuttered and no new referrals are being accepted. Legislators adjourned last week but are expected to return to work on the budget.

"We are continuing to work closely with our partners in the General Assembly with the goal of securing the resources needed to continue this critical and impactful program," the NCDHHS said.

Montiara Brown of Greenville said HOP helped her with rent, utility bills and groceries and estimates it saved her $200 to $300 per month. The program also helped her cover a security deposit on her residence and make her first utility payment.

Brown became a Medicaid recipient in 2020 after her son was born. The state's Medicaid expansion in 2023 allowed her to keep receiving benefits.

Two weeks ago, when Brown was informed that Pitt County DSS would no longer be receiving referrals to the HOP program, she was shocked.

"I didn't believe it," Brown said. "I've got a little anxiety because now, where am I going to go to when I need a little help?"

Brown works two jobs. She said her rent just increased and that her utility bills are higher over the summer with her kids home from school. She is a single mother to her 5-year-old son and took in his sister, 16, almost two years ago.

"It would have been nice if they would have had at least waited until after summer to do it," Brown said. "In the summertime, I have a little more expenses.

"Some people were already struggling, and getting that little help was helping them get by," Brown said. "I know some people are ... going to have a hard time without it because some people are a bill away from homelessness. They're really going to be hurting a lot of people with this."

HOP's shuttering coincides with the final passage of President Donald Trump's One Big Beautiful Bill Act. The bill includes $1.2 trillion in cuts to Medicaid and the Supplemental Nutrition Assistance Program. The nonpartisan Congressional Budget Office estimates the proposal will see 11.8 million more people go without health coverage.

Data from the NC Alliance for Health predicts that Medicaid work requirements alone could cost 255,000 North Carolinians their health care coverage; other estimates are higher.

Thomas Knight, economic services program administrator for the Pitt County Department of Social Services, said that all Medicaid recipients with a managed care plan were eligible for HOP. As of April, he said there were 34,952 eligible enrollees in Pitt County.

Since DSS can no longer refer Medicaid recipients to HOP, Knight has had to pick multiple organizations to cover some of the same needs. He said the department currently does not have a direct source to help clients with utility bills.

"HOP was a reliable referral source that we had," Knight said. "Once we referred them to HOP, we didn't know the outcome, but what we heard from our clients on the backend, we heard that it was very beneficial from the referrals that we made."

No other source has the same versatility, Knight said.

"HOP was not just limited to one category; it was across the board," Knight said. "HOP was all in one. It helped clients with so many varieties of needs and, right now, we're not having that ... one place they can go to and get all those services. I think that's the biggest impact we are seeing here.

"It kind of put the clients in a bind, unfortunately, because the people that are needing these services are really needing these services; they are not just coming because they can get it."

Jenny Ryan, director of community engagement at the Food Bank of Central and Eastern North Carolina, said that HOP investments provided more than 833,000 nutritious meals in communities where food banks were already active. There were plans to extend the food bank's investment with HOP to Pitt County, she said.

Ryan said the program's nutrition options were tailored to medical needs and that shared case management efforts between HOP and the food bank made "significant improvements" in the lives of people with chronic conditions.

"We've also created more than 300 jobs by sourcing food and packaging directly from area farms, retailers and small businesses — a meaningful investment in our local economy at a time of significant uncertainty," Ryan said. "Unfortunately, the state budget breakdown has indefinitely postponed our plans to bring these investments in health and well-being to the Greenville area."

Brown said the premade meals, fruits and vegetables distributed by HOP helped her lose weight and make better food choices. She also had to schedule fewer appointments with her physician while she was in HOP, she said.

"My overall health and feeling better was doing better," Brown said.