By Andrew Jacobs
Photographs by Allison Joyce
- Sept. 29, 2025Updated 9:07 a.m. ET
Five years ago, North Carolina embarked on a bold experiment to road test the idea that providing nutritious food, safe housing and transportation for doctors’ visits can help fragile Medicaid recipients stay healthy and avoid costly hospital stays.
For Krista Shalda, a single mother of two boys with complex medical needs, that meant receiving a weekly box of fresh produce. The provisions made it easier to stick to the special diet that reduced her 15-year-old’s trips to the emergency room.
Kellie Prince, who learned she had become homeless while recuperating from spinal surgery, was given a motel room for several weeks so she and her family didn’t have to sleep in a car in the hospital parking lot.
And for Debra Hensley, 60, who is partially blind and physically disabled, the new roof and electrical work paid for by the Medicaid program, the Healthy Opportunities Pilot, or HOP, allowed her to stay in the aging trailer she shares with her teenage grandson.
“It’s not an exaggeration to say that HOP saved my life,” said Ms. Hensley, gesturing to holes in the ceiling that had previously channeled rain water into her living room.
By many accounts, the $650 million set side for North Carolina’s Medicaid experiment was a success, and it enjoyed bipartisan support in the state’s Republican-led General Assembly.
An analysis by the UNC School of Medicine found the program saved $1,000 annually for each of the 13,000 Medicaid recipients enrolled in the pilot, which covers three rural swaths of the state.
But the program is shutting down, an early casualty of the cuts to Medicaid that Congress approved in July. In declining to renew funding, state Republican leaders cited looming reductions in federal health care spending in President Trump’s legislation, which extends tax cuts and slashes social safety net programs.
State lawmakers have until Sept. 30 to reverse course and fund the pilot for another five years, but many participating organizations have already discontinued services, and some have shut down entirely.
“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,” said Laurie Stradley, chief executive of Impact Health, a nonprofit in Asheville that helped administer the program in western North Carolina. “We’re going to see ripple effects for years to come.”