The end of North Carolina’s groundbreaking Medicaid experiment reveals how ideology and short-term politics can derail long-term health reform — even when the data proves it saves lives and money.
In the quiet mountains of western North Carolina, the Healthy Opportunities Pilot (HOP) was rewriting the playbook for public health. It wasn’t a new drug or a billion-dollar hospital expansion that was changing lives — it was boxes of fresh produce, safe housing repairs, and reliable transportation.
HOP began as an ambitious experiment under a $650 million federal waiver first approved by the Trump administration: could food, housing, and community support be prescribed like medicine — and paid for with Medicaid dollars?
For 38,000 participants, the answer appeared to be yes. Patients saw fewer emergency-room visits, chronic illnesses reversed, and, according to researchers at UNC-Chapel Hill, HOP saved an average of $1,020 per person annually in healthcare costs. For Rebecca Smith, a recovering addict from Graham County, the program didn’t just treat her diabetes — it helped her rebuild her life.
“I was snacking on grapes instead of chips,” she said. “After a few months, I wasn’t diabetic anymore.”
