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Understanding Healthy Opportunities
Melanee R., Social Work Intern for Respite
I’m excited to be writing to this community again, now in a new role. Previously the Storyteller at Haywood Street, I now serve as the social work intern for Respite—and I couldn’t be more grateful! As I explore Respite in a new role, I am also gaining a better understanding of how the Healthy Opportunities Pilot (HOP) program, which is currently paused, significantly affected us and many other organizations and individuals in the region.
Here's a quick summary for those, like me, who may not have known HOP’s full impact: The Pilot was authorized through NC’s Medicaid Section 1115 waiver, which enables the state to use both federal and state Medicaid funds—up to $650 million over the waiver period—to test services addressing non-medical conditions that affect a person’s health outcomes (like air pollution, food security, or housing status).[1] This is also called a “whole-person” medical approach.
HOP’s approach to health was proactive, far different from the traditional symptom-focused approach most of us know. This meant that organizations could bill Medicaid for food box distributions with produce from local farms, mold remediation in homes affected by flooding and excess moisture, transportation to appointments, and more.
Bringing it home: In 2022, Respite was one of the few organizations chosen to participate in the pilot. For Respite, this meant expanding our services to assist more people in need of medical respite care and increasing staffing, including a nurse, a peer support specialist, an LCSW, and additional overnight support. It also laid the groundwork for the expansion project you might be following in our newsletters and on social media, which is currently in progress.
The pilot organizations that signed on expected a five-year demonstration period, during which enrollment, service provision, and data collection would take place. The sudden, unexpected pause that occurred in July, therefore, has left a massive service gap affecting about 30,000 Medicaid recipients.[2] The loss of this funding source has strained Respite, resulting in fewer staff and a reduced number of friends we can serve. This means that once our expansion project is finished, we might not be able to use all 25 beds.
And the most puzzling part of this? During the years it was actively retrieving data, the HOP program actually showed positive outcomes (see here and here).
This program was a lifeline and a glimmer of hope for the most vulnerable folks in our community. The opportunity for our legislators to restore HOP is still there since they have not yet approved a budget for 2026. It requires a little effort on our part, though. Before NC budget negotiations begin again in April, we will be actively reaching out to our representatives, and we invite you to join us in that effort. Linked below are a sample email and contact information for the NC legislators serving our region.
Click here for information on sending an email.
[1] https://ncmedicaljournal.com/article/94844-reflecting-on-nearly-two-years-of-north-carolina-s-healthy-opportunities-pilots
[2] https://www.northcarolinahealthnews.org/2025/06/03/funding-cut-for-healthy-opportunities/
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