Once a Model Program, Now a Memory
Just one year after Hurricane Helene devastated western North Carolina, a groundbreaking Medicaid initiative that provided food, housing, and transportation to the state’s most fragile residents has been abruptly discontinued—leaving thousands without critical support.
The program, known as the Healthy Opportunities Pilot (HOP), was launched five years ago with $650 million in federal and state funding. Designed to test whether addressing social needs like nutrition and shelter could improve health outcomes, it quickly became a national model—earning rare bipartisan praise in North Carolina’s Republican-led legislature.
Real Lives, Real Impact
For residents like Krista Shalda, Kellie Prince, and Debra Hensley, HOP wasn’t just helpful—it was lifesaving.
- Krista Shalda, a single mother of two boys with complex medical conditions, received weekly boxes of fresh produce that kept her 15-year-old son out of the ER.
- Kellie Prince, recovering from spinal surgery, was given temporary motel housing after learning she’d become homeless—preventing her family from sleeping in a hospital parking lot.
- Debra Hensley, 60, partially blind and disabled, got a new roof and electrical repairs on her aging trailer, allowing her to safely care for her teenage grandson.
“It’s not an exaggeration to say that HOP saved my life,” said Ms. Hensley.
Why Was the Program Cut?
Despite its documented success in reducing hospitalizations and emergency visits, the pilot was always time-limited. Federal waivers allowed North Carolina to test HOP in select regions—but permanent expansion required additional state and federal approvals that never materialized.
With Hurricane Helene compounding existing poverty and infrastructure damage in 2024, the end of HOP in late 2025 has hit especially hard.
Before and After: The HOP Effect
| Metric | During HOP (2020–2024) | After HOP Ends (2025) |
|---|---|---|
| ER Visits (Western NC) | ↓ 28% among participants | ↑ 19% projected |
| Housing Stability | 92% avoided homelessness | No state safety net |
| Food Security | Weekly produce for 12,000+ families | Reliant on food banks |
What’s Missing Now?
Without HOP, vulnerable residents must navigate a patchwork of underfunded local services:
- [INTERNAL_LINK:medicaid-expansion] remains stalled in many Southern states
- Food banks report 40% increase in demand since HOP ended
- No Medicaid-funded housing assistance exists post-pilot
A National Warning Sign?
North Carolina’s experience raises urgent questions about the sustainability of social-health integration programs. While HOP proved that “food is medicine” and “housing is healthcare,” its termination shows how fragile such innovations remain without permanent policy backing.
Advocates are now pushing Congress to allow states to permanently include social services in Medicaid benefits—a move opposed by some fiscal conservatives.
