Five years ago, North Carolina launched an innovative experiment: could providing essential support like nutritious food, stable housing, and reliable transportation improve the health of vulnerable Medicaid recipients and reduce expensive hospitalizations?
For Krista Shalda, a single mother with two boys facing complex medical challenges, this meant receiving a weekly delivery of fresh produce. These provisions were crucial, helping her maintain a special diet that significantly reduced her 15-year-old son’s emergency room visits.
Kellie Prince, who found herself homeless while recovering from spinal surgery, received temporary motel accommodation, ensuring her family didn’t have to sleep in their car outside the hospital.
Debra Hensley, a 60-year-old woman with partial blindness and physical disabilities, benefited from a new roof and electrical repairs on her aging trailer, paid for by the Healthy Opportunities Pilot (HOP) Medicaid program, allowing her to continue living there with her teenage grandson.
Ms. Hensley emphasized the program’s profound impact: “It’s not an exaggeration to say that HOP saved my life,” she remarked, pointing to the ceiling where rainwater used to pour into her living room.
With $650 million invested, North Carolina’s Medicaid experiment was largely considered a success, earning bipartisan backing from the state’s Republican-led General Assembly. A study by the UNC School of Medicine confirmed its effectiveness, reporting that the program saved $1,000 annually for each of the 13,000 Medicaid participants across three rural regions of the state.
Images depict Debra Hensley, Krista Shalda with her two sons, and Kellie Prince preparing dinner for her family.
Despite its proven benefits, the program is now being discontinued, a direct consequence of Medicaid cuts approved by Congress in July. State Republican leaders attributed their decision not to renew funding to anticipated federal healthcare spending reductions outlined in President Trump’s legislation, which extends tax cuts while drastically slashing social safety net programs.
Lawmakers in the state have until September 30th to reconsider and reinstate funding for the pilot program for another five years. However, many participating organizations have already ceased operations, and some have been forced to close completely.
Laurie Stradley, CEO of Impact Health, a nonprofit that helped manage the program in western North Carolina, expressed deep concern: “There’s a lot of heartache and disappointment to watch the demise of something that was stabilizing the community and helping people get back on their feet. We’re going to see ripple effects for years to come.”
These cuts are part of a larger $320 million reduction in Medicaid spending by the North Carolina Legislature, a move healthcare analysts warn will significantly diminish benefits for the state’s three million Medicaid recipients.
Photos show Ms. Hensley inside her trailer, which received a new roof thanks to HOP funding, and Ms. Prince picking up her grandchildren from school.
North Carolina’s decision foreshadows significant shifts in American healthcare, with over $900 million in projected Medicaid cuts expected nationwide over the next decade. The Congressional Budget Office estimates that nearly eight million individuals could lose their Medicaid coverage by 2034.
Krista Shalda and her two sons, both on the autism spectrum, experienced firsthand the fragility of their situation after Hurricane Helene. Floodwaters engulfed their suburban Asheville home, forcing them to live in shelters and motels for months. Since November, they’ve resided in a donated recreational vehicle beside their damaged house.
Ms. Shalda expressed her frustration with the state’s decision, stating, “North Carolina legislators seem to think we’re just a bunch of hillbillies and don’t deserve a helping hand.”
Dr. Seth A. Berkowitz, a primary care physician at the UNC School of Medicine and an evaluator for the federal Centers for Medicare & Medicaid Services, affirmed the pilot’s success in stabilizing families during difficult times. He described it as addressing a “straw that broke the camel’s back” scenario, where a family barely coping faces a job loss or a vehicle breakdown.
Dr. Berkowitz observed that while initial spending per participant rose due to prescribed services—such as mold removal for a child’s asthma—overall healthcare expenditures for these individuals decreased over time.
“If you spend resources to get people through a rough patch, that translates down the line to better health and lower health care spending,” he explained.
Beyond individual health, the pilot program also stimulated the local economy by channeling a significant portion of its funds through regional social service agencies, food banks, and farms.
For many farmers, the news of the program’s closure came at a particularly bad time, as their spring crops were already planted. “For us, the timing is terrible,” commented Nicole DelCogliano, an organic vegetable farmer in Yancey County.
Pictured are Nicole DelCogliano and her husband, Gaelan Corozine, on their Green Toe Ground farm in Burnsville, N.C., which suffered damage from Hurricane Helene last year.
The income generated from HOP was instrumental in helping DelCogliano’s family recover after Hurricane Helene inflicted $250,000 worth of damage to their farm. “And personally speaking, it was especially gratifying to know our food was going to people who really needed it,” Ms. DelCogliano shared.
Much of the farm’s fresh produce was distributed through a network of a dozen community markets run by the nonprofit Bounty & Soul in low-income areas around Asheville. These markets function like traditional farmers’ markets, but with one crucial difference: shoppers receive farm-fresh produce without any cost.
Paula Sellars, the deputy director of Bounty & Soul, reported that these community markets now serve 26,000 people monthly, a figure that has doubled since before Hurricane Helene.
While the community markets will continue, the termination of the HOP program means that 260 Medicaid recipients with severe health conditions will no longer receive weekly boxes of fruits, vegetables, and eggs from Bounty & Soul. Ms. Sellars emphasized the importance of these provisions: “With all its micronutrients, fresh produce is the foundation of good health. Rather than chasing disease, supporting people’s well-being is actually the smart economic choice, and the humane choice.”
For Ms. Shalda, this fresh produce had been a true lifeline.
Her eldest son, Alex, 15, a thoughtful and kind young man, was born with hydrocephalus, a condition involving fluid accumulation in the brain. Throughout his life, he has faced numerous hospitalizations and surgeries, making him particularly vulnerable to convulsive seizures and kidney stones.
When Alex’s doctor prescribed a detailed, two-page diet rich in fresh vegetables, dairy, and meat to manage his conditions, Ms. Shalda initially despaired, knowing these items were largely unaffordable on the family’s $700 monthly food stamp allowance.
Krista Shalda and her sons are shown living in temporary housing as their flood-damaged home undergoes repairs, alongside an image of people lining up for donated food from Bounty & Soul in Asheville.
The HOP food boxes were meticulously prepared to meet the family’s specific dietary requirements, including fresh eggs, cheese, bread, and a variety of seasonal produce. Ms. Shalda was so thrilled she often shared photos of her refrigerator, brimming with healthy options, with friends. Gradually, Alex’s frequent hospitalizations due to seizures and kidney stones began to decrease.
“It’s been such a relief to watch him run around crunching on carrots and peppers instead of eating junk food,” she shared.
However, since the food deliveries ceased in July, Ms. Shalda has resorted to serving more frozen and canned vegetables. As she recounted this, her sons visibly reacted. “The frozen carrots tasted like mush,” Alex complained.
Recently, the discomfort from his chronic kidney stone condition has started to return.
Ms. Shalda worries deeply about the future, anticipating further hardship as federal cuts to Medicaid and food stamps take hold.
“I feel overwhelmed just thinking about the future,” she admitted.
Kellie Prince, responsible for three grandchildren, shares this profound anxiety. With the weekly food boxes no longer arriving, Ms. Prince now frequents local food pantries. However, these often lack fresh produce and limit visits to once every two weeks. “The kids really used to look forward to the strawberries, bananas and eggs,” she said, adding with a sigh, “Have you seen the price of eggs lately?”
Images depict Ms. Prince with her grandchild, Klover, and later in the hospital, recovering from a series of small strokes.
After nearly a year in shelters and motels, Ms. Prince’s husband secured a $20-an-hour job with the Asheville Housing Authority. This enabled the family to rent a two-bedroom apartment in Black Mountain. However, his new income also rendered the family ineligible for their $173 in monthly food stamps, and Ms. Prince lost $798 in federal disability payments.
Despite her cheerful demeanor, the 55-year-old Ms. Prince has been unable to work since a car accident left her with numerous health problems. In July, she received a breast cancer diagnosis and underwent a double mastectomy.
Recently, Ms. Prince shared the immense difficulties of raising three grandchildren under eight on a restricted budget, all while battling post-surgery complications including persistent swelling, constant pain, and alarming blood clots.
“It’s hard to recover properly when you can’t get any sleep and you’re worried all the time about feeding your family,” she explained, as her youngest grandchild, Klover, moved restlessly in her arms.
The Prince family’s journey perfectly illustrates the core purpose of the HOP program: it offered a pathway out of homelessness and supplied nutritious food, forming the bedrock for healthy living. Conversely, the abrupt withdrawal of this support underscores how the relentless pressure of poverty can severely undermine health.
“I’m not one to complain, but it’s been hell,” she confided quietly, once her grandchildren were out of earshot.
Just a few days later, Ms. Prince was rushed to the emergency room, unable to speak as the right side of her body went numb. Doctors confirmed she had suffered a series of small strokes.
After a five-day hospital stay, she was discharged with firm instructions: prioritize healthy eating, adequate rest, and stress reduction—a daunting task given her circumstances.