By Clarissa Donnelly-DeRoven
North Carolina’s state Medicaid office is sending millions of dollars to organizations that help people with housing, domestic violence, and other chronically stressful situations.
By paying these agencies to help people on Medicaid with extreme life stressors, the state hopes it can help those same people avoid illness and in the process save money that would otherwise be spent on health care.
The project, called the Healthy Opportunities Pilot, or HOP, began its three-phase roll out in March after years of planning. It started with services to reduce hunger, which many say are going pretty well. In May, the pilot began funding housing and transportation services. In June, the state planned to begin reimbursing organizations that deal with domestic violence.
Some portions of the project have been stalled, though.
Researchers have long documented the ways that extremely stressful situations, such as homelessness and domestic violence, impact mental and physical health. The last two decades have also brought research showing how these events can wreak havoc on the mind and body.
Experiencing and coping with stress is a critical part of human development. Stress – in moderate amounts – is designed to keep us safe. The so-called “fight or flight” response causes the heart to start beating faster, blood vessels to restrict to more quickly push blood, oxygen, and other nutrients throughout the body. We make hormones – like adrenaline – that can give the energy needed to fight, flight, or flee. Our immune system turns up its inflammatory response.
As the body tunnels all its energy into overcoming a stressful situation, it diverts resources from other energy-intensive bodily processes, such as reproduction and the part of the brain that deals with decision-making and controlling emotions.
Over short periods of time, the response works. But if it never turns off — which is what happens when you’re constantly worried about where you’ll sleep, or if your partner will put you in the hospital again — that’s where problems start.
A heart pumping too hard for too long can cause vascular disease, high blood pressure, and increase the likelihood of a heart attack. Too many stress hormones can exacerbate conditions like diabetes, while reproductive hormones needed to sustain a healthy pregnancy can struggle to turn back on after being suppressed for too long.
An overactive inflammatory response can lead to the suppression of the immune system