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.

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.

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 had trusted relationships on the ground.

We were honest about what we didn’t know. Policymakers on both sides are rightly skeptical of programs that overpromise. We presented HOP as a test — a rigorous evaluation with defined endpoints — not a fait accompli. That honesty created credibility.

The Healthy Opportunities Pilots program is pragmatic, people-focused, willing to test new ideas and follow the evidence. We believe that’s exactly what our country needs right now. With this new evidence in hand, North Carolina’s legislators voted in July to continue the program, which was paused in the state’s budget impasse last year, scaling access to key drivers of savings and help close the gap in Medicaid state funding.

Congress should codify pathways for states to integrate evidence-based social services into Medicaid rather than forcing every state to fight for a waiver independently. In the meantime, the Centers for Medicare and Medicaid Services can act now — expanding guidance and waiver authority — and states should deploy rural health transformation funds toward exactly this kind of innovation.

Health care affordability will be solved by building durable coalitions around ideas that work in the real world, not just in theory. North Carolina ran the experiment. The savings are real, the lives improved are real, and the cross-aisle collaboration that made it possible is real.

North Carolina proved that pragmatism can beat partisanship. The results are in. It’s time to replicate what works.

Mandy Cohen, M.D., M.P.H., served as North Carolina’s secretary of health and human services from 2017 to 2022 and director of the CDC from 2023 to 2025. She is currently a national adviser at Manatt Health. Kody Kinsley, M.P.P., served as North Carolina’s secretary of health and human services from 2022 to 2025 and is currently a senior policy adviser at the Johns Hopkins University Institute of Policy Solutions.