A North Carolina Medicaid Program Worked on Every Level—And Got Killed
“In early 2023, Rebecca Smith was two months sober and looking for help. Her addiction to methamphetamines had cost her custody of her children, and she’d moved back home to Graham County, North Carolina, to rebuild her life. High cholesterol and heart problems ran in her family, and during her struggle with addiction she had been diagnosed with diabetes. She knew that staying sober would require taking better care of herself.
She discovered Five Point Center, a nonprofit in her tiny, Great Smoky Mountains town that offered recovery support as well as free meals and groceries. Workers there told her about a new Medicaid program, the Healthy Opportunities Pilot, that would deliver boxes of fresh food to her home for free every week.
Soon Smith, 35, was snacking on grapes instead of chips. She tried mangoes for the first time, and prepared Southwest chicken from a recipe that came with her box. She learned to stretch her food budget so she didn’t need to apply for the Supplemental Nutrition Assistance Program and even got a job helping to pack the HOP boxes every week. “It was easy to prepare the things that came in the HOP boxes, instead of going through a drive-through,” Smith said.
After a few months in the program, Smith was no longer diabetic, and she has now been sober for two and a half years.
Her story highlights the success of the Healthy Opportunities Pilot, which launched in North Carolina in March 2022. The program had benefits beyond health and quality-of-life improvements; researchers at UNC-Chapel Hill found the program saved $1,020 a year per recipient on health care costs, and the 38,000 participants had “significantly lower” emergency room visits than their peers.
The program was unique, funded with a five-year, $650 million federal grant approved by the first Donald Trump administration. The idea was to use fresh food, safe housing and transportation — social and economic factors that researchers say determine 80 percent of a person’s health — to improve the lives of the sickest, most expensive patients.
Such non-medical, healthy food-based interventions are a key component of the Make America Healthy Again movement that helped propel Trump to a second term. Calley Means, an adviser to Health and Human Services Secretary Robert F. Kennedy, Jr., told POLITICO in April, “Food is medicine. … It is demonstrable clinically that often these diseases are food-related,” referring to chronic illnesses such as diabetes, obesity and dementia. (Means did not respond to requests for comment.)