Just five years ago, North Carolina launched an ambitious pilot program designed to keep its most vulnerable Medicaid recipients healthy by providing essential support like nutritious food, stable housing, and reliable transportation to medical appointments. The innovative approach aimed to reduce expensive hospital stays by addressing basic social determinants of health.
For Krista Shalda, a single mother navigating the challenges of two sons with complex medical needs, this program meant a weekly delivery of fresh produce. These vital provisions made it significantly easier to maintain the specialized diet crucial for her 15-year-old, directly reducing his frequent visits to the emergency room.
Kellie Prince, discovering herself homeless while recovering from spinal surgery, received temporary relief through the program: a motel room for several weeks. This critical assistance ensured she and her family avoided sleeping in their car in the hospital parking lot.
Debra Hensley, a 60-year-old with partial blindness and physical disabilities, saw her living conditions drastically improve thanks to the Healthy Opportunities Pilot (HOP) Medicaid program. HOP funded a new roof and essential electrical work for her aging trailer, allowing her to safely remain in her home with her teenage grandson.
“It’s no exaggeration to say HOP saved my life,” Ms. Hensley stated, pointing to ceiling holes that once funneled rainwater directly into her living room.
By all accounts, North Carolina’s $650 million Medicaid experiment was a resounding success, even garnering bipartisan approval within the state’s Republican-controlled General Assembly.
An analysis from the UNC School of Medicine revealed that the program was not only effective but also cost-efficient, saving an average of $1,000 annually for each of the 13,000 Medicaid recipients across the three rural regions it served.
Despite its proven success, the HOP program is now slated for termination. This decision is an early consequence of significant Medicaid cuts passed by Congress in July. State Republican leaders justified their refusal to renew funding by pointing to anticipated reductions in federal healthcare spending, outlined in President Trump’s legislation that extends tax cuts while simultaneously reducing social safety net programs.
Although state lawmakers have until September 30th to reconsider and reinstate funding for another five years, many organizations involved in the pilot have already ceased operations or discontinued services, leaving a void that is difficult to fill.
“It’s truly heartbreaking to witness the end of a program that brought stability to our community and helped so many get back on their feet,” expressed Laurie Stradley, CEO of Impact Health, a nonprofit that helped manage HOP in western North Carolina. “The long-term repercussions of this decision will be felt for years.”
These cuts are part of a broader $320 million reduction in Medicaid spending by the North Carolina Legislature, a move healthcare analysts warn will severely diminish benefits for the state’s three million Medicaid recipients.
The decision to cancel the pilot program is particularly devastating for residents in and around Asheville, North Carolina. This mountainous region is still reeling from the catastrophic flooding caused by Hurricane Helene just one year prior.
Many locals feel abandoned, especially after the Federal Emergency Management Agency (FEMA) announced in May that it would no longer fully cover the costs of state recovery efforts.
While the stunning Blue Ridge Mountains and Asheville’s vibrant arts community have attracted wealthy retirees and remote workers, the rapidly escalating housing costs have made the region increasingly inaccessible for low-wage earners in a state with a mere $7.25 minimum wage.
Attempts to reach State Senator Ralph Hise, whose district benefited from the pilot, and other Republican leaders in the General Assembly for comment were unsuccessful.
Publicly, some politicians have expressed skepticism about the program’s real impact.
“From our perspective, it’s simply not clear that anyone is truly benefiting from this program,” stated House Speaker Destin Hall in June.
North Carolina’s action serves as a stark preview of the monumental shifts awaiting American healthcare. Over the next decade, more than $900 million in projected Medicaid cuts are set to dramatically reshape the landscape. The Congressional Budget Office estimates that nearly eight million people could lose their Medicaid coverage by 2034.
After their suburban Asheville home was ravaged by floodwaters, forcing them to flee in the dark, Ms. Shalda and her two autistic sons spent months moving between shelters and motels. Since November, their temporary residence has been a donated recreational vehicle, parked beside their water-damaged house.
“North Carolina lawmakers appear to believe we’re simply ‘hillbillies’ who don’t merit any assistance,” Ms. Shalda remarked, commenting on the program’s termination.
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 supporting families during critical times. “We often see ‘the straw that breaks the camel’s back’ situations – families barely coping, then a job loss or a car breakdown pushes them over the edge,” he explained.
Dr. Berkowitz noted that while initial spending per participant rose as they received essential services, such as mold remediation to alleviate a child’s asthma, the overall spending trend decreased over time.
“Investing in people during their struggles ultimately leads to improved health outcomes and reduced long-term healthcare costs,” he concluded.
Beyond health benefits, the pilot significantly boosted the local economy by channeling substantial funding through regional social service agencies, food banks, and farms.
Many local farmers, including Nicole DelCogliano, who cultivates 30 varieties of organic vegetables along the South Toe River in Yancey County, had already planted their spring crops when the program’s closure was announced. “The timing is simply devastating for us,” DelCogliano lamented.
The income from HOP had been crucial for her family to recover after Hurricane Helene inflicted $250,000 in damages to their farm. “And personally, it was incredibly rewarding to know our produce was reaching those who desperately needed it,” Ms. DelCogliano shared.
A significant portion of the farm’s harvest was distributed through a dozen community markets managed by the nonprofit Bounty & Soul, serving low-income neighborhoods in and around Asheville. These markets function much like traditional farmers’ markets, but with a crucial difference: shoppers receive fresh, local produce free of charge.
Paula Sellars, Deputy Director of Bounty & Soul, reported that these community markets now serve 26,000 individuals monthly, a figure that has roughly doubled since Hurricane Helene.
While the community markets will persevere, the cessation of the HOP program means 260 Medicaid recipients with significant health challenges will no longer receive weekly boxes of fruits, vegetables, and eggs from Bounty & Soul. “Fresh produce, with all its micronutrients, is fundamental to good health,” Ms. Sellars emphasized. “Prioritizing people’s well-being isn’t just the humane option; it’s the economically sensible one.”
For Ms. Shalda, this fresh produce was a true godsend.
Her eldest son, Alex, 15, a tall, gentle, and insightful teenager, was born with hydrocephalus, a condition involving fluid buildup in the brain. Throughout his life, he has faced numerous hospitalizations and surgeries, making him particularly prone to convulsive seizures and painful kidney stones.
When Alex’s doctor prescribed a strict, two-page-long diet rich in fresh vegetables, dairy, and meat to manage his conditions, Ms. Shalda was overwhelmed. These essential foods were nearly impossible to afford on the family’s modest $700 monthly food stamp allowance.
The customized HOP food boxes perfectly met the family’s strict dietary requirements, arriving packed with two dozen eggs, cheese, bread, and a vibrant selection of seasonal produce. Ms. Shalda was so delighted that she frequently shared photos of her overflowing refrigerator with friends. Gradually, Alex’s frequent seizures and kidney stones, which often led to hospital visits, became less common.
“It’s been such a relief to see him happily munching on carrots and peppers, instead of reaching for unhealthy snacks,” she added.
Since the food deliveries ceased in July, Ms. Shalda has resorted to serving more frozen and canned vegetables. As she spoke, her sons visibly grimaced. “The frozen carrots just tasted like mush,” Alex declared.
Consequently, the discomfort from his chronic kidney stone condition has recently started to intensify.
Ms. Shalda expressed profound worry that the situation will only deteriorate further once federal cuts to Medicaid and food stamp programs are fully implemented.
“I feel completely overwhelmed contemplating what the future holds,” she admitted.
Ms. Prince, now a caregiver for three grandchildren, shares similar anxieties. With the weekly food boxes gone, she now navigates local food pantries, which rarely provide fresh produce and often limit visits to once every two weeks. “The kids genuinely loved the strawberries, bananas, and eggs,” she recalled. “And have you seen how much eggs cost now?”
After enduring 11 months in shelters and motels, her husband secured a $20-an-hour position with the Asheville Housing Authority, enabling the family to rent a two-bedroom apartment in Black Mountain. However, this increased income paradoxically rendered them ineligible for their $173 in monthly food stamps, and Ms. Prince simultaneously lost $798 in federal disability payments.
Despite her normally cheerful and resilient demeanor, 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 subsequently underwent a double mastectomy.
During a recent afternoon, Ms. Prince detailed the immense struggles of raising three grandchildren under the age of eight on a tight budget, all while battling post-surgery complications. These included persistent swelling, constant pain, and alarming blood clots that deeply concerned her physician.
“It’s incredibly difficult to heal properly when sleep is scarce and you’re constantly consumed by worries about feeding your family,” she confided, as Klover, her youngest grandchild, fidgeted in her arms.
The Prince family story perfectly illustrates the core purpose of the HOP program. It successfully guided them out of homelessness and equipped them with the foundational elements for nourishing meals.
Conversely, the abrupt loss of this support starkly demonstrates how the pervasive stress of poverty can severely undermine health. “I’m not one to complain, but it’s been absolute hell,” she whispered in a private moment, ensuring her grandchildren were out of earshot.
Days later, Ms. Prince was emergency-rushed to the hospital after experiencing numbness on her right side and losing the ability to speak. Doctors confirmed she had suffered a series of small strokes.
Following a five-day hospitalization, she was discharged with stringent instructions: maintain a healthy diet, get ample rest, and rigorously avoid stress.