In western North Carolina, 13.3% of the population, nearly 130,000 people, live in poverty, and almost three out of ten households experienced food insecurity in 2024, according to the Regional Needs Assessment 2026 from Impact Health, an Asheville-based organization that serves the western counties of the state.
Until July 1, 2025, this same organization coordinated the Healthy Opportunities (HOP) pilot program in the region. And HOP was specifically designed to help these families. Through Medicaid fundsIt addressed health in a comprehensive way and covered the costs of food, housing and transportation.
This week, the North Carolina Department of Health and Human Services (NCDHHS) announced the returnOn a smaller scale, the program was affected. HOP was paralyzed when the General Assembly did not allocate funds to it in 2025Approximately 10,900 people in the region were left without that support.
“It will be a smaller start. Healthy food boxes will be the first service to resume, and eligibility will be more limited,” explained Laurie Stradley, CEO of Impact Health. Enlace Latino NC .
The new budget for HOP consists of $9 million from the state, which, combined with federal funds, totals approximately $25 million. It covers the three pilot regions (33 counties) and is expected to last for six months, until June 2027, when legislators will discuss the new budget.
“We are incredibly grateful that the General Assembly included funding for Healthy Opportunities,” Stradley said.
However, the funds are nowhere near the amount the program was handling before its suspension. According to the director of Impact Health, it's only "10% of what we initially requested."
What does this return mean and how will it impact a region where One in three residents is eligible for Medicaid And where is poverty highest among Latino and African American residents?
A limited return for the west as well
In the West, the program will return to the 18 counties coordinated by Impact Health, including Buncombe and Henderson, but only with boxes of healthy food.
It is much smaller than what the region had in the previous stage. Between March 2022 and January 2025, HOP distributed 144,595 boxes of food in the west and provided more than 283,000 food, housing, and transportation services. That $75 million investment generated $114 million in business activity and 898 jobs, according to a Economic analysis of Impact Health.
The program's return, however, will share $25 million among the three regions that comprise it. The NCDHHS anticipates that approximately 7,400 people could qualify in total, the agency reported. Enlace Latino NC .
“It’s a reboot, but it’s almost a rebuild,” Stradley said.
This refers to the fact that having stopped running a program of this type for more than 16 months and resuming it with a limited budget will have consequences when implementing it.
The difficult task of regaining trust
Impact Health doesn't yet know which organizations will participate. It's talking to its former partners to explain how this phase will work and how much they'll be reimbursed, and to ask if they want to return.
Stradley knows it won't be easy to get the allies to trust each other again.
After HOP closed, many organizations had to scale back their work or find other ways to sustain it. Caja Solidaria, for example, which served about 530 families a week in Henderson and Transylvania counties, had to cut its delivery routes and notify farmers that it could no longer buy from them.
That was just one of the cases. Impact Health was working with more than 60 community partners as part of the pilot program.
“One of the most painful things, as an organizer and community leader, was feeling like we let these organizations down. We encouraged them to join this incredible pilot program, but when it was stopped so abruptly, they had to lay off staff. They had to tell the people they were supporting that they could no longer do so. It felt like a breach of trust at every level, from the state down to our organization and below, for not being able to uphold it,” Stradley said.
Stradley expects fewer organizations to participate at this stage because he can't yet guarantee the program will continue beyond June. He says he understands.
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The need in western North Carolina
La food insecurity In the West, it varies greatly from county to county. In 2024, it ranged from 16.6% of households in Polk County to 41.7% in Rutherford, according to Impact Health's assessment.
The same report identifies Latino households as one of the groups where the problem is growing. More than 78,000 Latinos live in the region, and Henderson and Buncombe are among the counties with the largest Latino populations.
For Stradley, transportation is also a factor. “It’s not just about whether you can buy the food, but whether you have enough gas in the tank to drive to the supermarket to buy it,” he said.
The program returns when The demand for food continues to riseThe MANNA FoodBank network now receives more than 220,000 visits per month across the 16 counties it serves, compared to 158,000 in 2023, according to [source missing]. their own records.
And more than 27% of rural households that turn to community organizations lost benefits in the last year, especially from Supplemental Nutrition Assistance Program (SNAP), according to a 2026 survey included in the assessment.
The future of the program after June
The program's future depends on the funding it receives in next year's state budget. Stradley hopes it will be more than what was allocated when it returned.
“I’m trying to be optimistic about the changes in elected officials and how much they seem to care about health, food, the cost of living and medical care. But it's a very difficult time to do this,” Stradley said.
The strongest argument for the success and necessity of this program relates to the creation of healthier communities. A study from the University of North Carolina found that its participants visited the emergency room less often and had fewer hospitalizations, and that HOP reduced healthcare costs by an average of $164 per person per month.
For Stradley, it is also necessary to take a closer look at these communities.
“I think more people need to get out of Raleigh, get out of their homes and just drive through communities that are quiet and hidden away, and find a way to be there and support those people, and do it with dignity,” he emphasized.
The implementation in the west
Families do not enroll directly with Impact Health. Medicaid health plan care managers verify their eligibility. if a person qualifies and they connect her with the community organization that will deliver the boxes.
Those who were receiving HOP before the suspension will not automatically return. They will have to undergo another non-medical needs assessment, as will those who are eligible for the first time, according to the NCDHHS.
There is no start date yet. The NCDHHS reported She said the organization will be notified at least 30 days before deliveries begin, and Stradley noted that the state is referring to the “first part of the year.” The delay, she explained, is due to requirements regarding the use of federal and state funds.
When a date is set, Impact Health will announce it through community and health promotion organizations. In the meantime, those who believe they qualify can inquire with their Medicaid health plan or call the NCDHHS Customer Service Center at 1-800-662-7030.
Who will be able to participate in HOP
The boxes will be delivered to homes every week. To receive them, a person must meet all of these requirements, according to the NCDHHS:
- Having a Medicaid health plan.
- Live in one of the program's three regions. In the west, there are 18 counties.
- To have food insecurity.
- Being pregnant, having diabetes, or having cardiovascular disease.
- Since the boxes are only delivered to homes, other requirements must also be met, for example, not being able to go to a community dining hall.
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They are excluded from HOP:
- In practice, almost all children will benefit, because it's rare for them to have these conditions. "The most disappointing thing is that not many children are going to receive any of this," Stradley said.
- Those who only have Emergency MedicaidThis coverage only covers emergencies. It is the coverage available to immigrants who are not eligible for full Medicaid due to their migratory status, including people without immigration status.
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