Until just a few weeks ago, every Thursday Catalina Noreña loaded her truck with fresh produce—boxes of tomatoes, blueberries, cilantro, beans—and drove the winding roads of Transylvania County. These routes belonged to Caja Solidaria, a community initiative that delivered healthy food—not donations, but medically prescribed groceries—to hundreds of families facing mobility barriers, low incomes, or chronic illness.
That all ended on June 30.
That day, the state officially ended the Healthy Opportunities Pilot (HOP)—a three-year program that enabled organizations like Caja Solidaria to operate as food pharmacies in rural areas via Medicaid.
The funding cut left more than 43,000 people across North Carolina without support—including approximately 10,900 in the western region. It also disrupted operations for many organizations and threatened jobs, farms, and community health networks.
“We don’t give away free food. We strongly believe that food is medicine,” said Catalina Noreña, part of the leadership team at Caja Solidaria in Brevard, in an interview with Enlace Latino NC.
“When the funding was withdrawn, it was devastating. We had to stop everything and rethink from the ground up how to move forward,” she said.
Now, Caja Solidaria is reinventing itself as a collective membership program, reverting to the model it used when it launched in 2020. Families who previously received food under HOP now contribute what they can, to keep operations running locally.
“Everyone contributes something. If someone can pay $5, they do—it allows those who can give more to subsidize others,” explained Noreña.
But Caja Solidaria’s transformation also highlights a broader issue: the void left by HOP’s termination in a region still recovering from Hurricane Helene, where distance, poverty, and health are deeply connected.
A national pilot experiment in North Carolina
HOP was the first comprehensive program in the U.S. to test—and evaluate—whether social interventions (like fresh food, safe housing, transportation, and violence prevention) could improve health outcomes for Medicaid recipients.
This approach is backed by evidence suggesting up to 80% of a person’s health outcomes are influenced by non-medical factors.
The pilot began in 2022 across three rural regions: the western region led by Impact Health; the northeast via Access East, Inc.; and the southeast, under Community Care of the Lower Cape Fear, per official state data.
Impact in the western region
In western North Carolina, Impact Health oversaw a network of over 60 human service organizations. Between March 2022 and January 2025, the region distributed 144,595 boxes of healthy food, provided housing and transportation support, and delivered more than 283,000 total services.
According to HOP’s 2024 year-end report, healthcare savings surpassed $1,000 per person per year.
Economically, the program was transformative. A $75 million investment reportedly generated $114 million in local economic activity and created 898 jobs across agriculture, construction, health, and food sectors.
“The Healthy Opportunities Pilot ended on June 30 in western North Carolina, as well as in the other two pilot regions,” Impact Health told Enlace Latino NC.
“We are hopeful HOP will be reinstated in the final state budget, but uncertainty remains about its future.”
Despite the closure, Impact Health pledged to continue providing technical support and training to participating organizations—including those serving Latino communities.
More than just food: health, dignity, community
Caja Solidaria was among the selected providers. Its community market did not offer pre‑packaged or processed items—instead, it provided fresh, locally sourced produce tailored to medical dietary needs.
“We’d drive the truck, open the back, and set out everything beautifully. People would shop right from the truck,” Noreña said. “It was dignified, fresh food. Being there wasn’t asking for help—it was community.”
Downsizing and tough decisions
Before funding ended, Caja Solidaria served approximately 530 families weekly across Henderson and Transylvania counties with 12 delivery routes and three market sites. Many lived in rural areas without transportation or nearby stores.
After HOP ended, the team reduced operations significantly. In Brevard, only eight families still receive home delivery—those who are elderly, chronically ill, or mobility‑challenged. Others must visit the new solidarity market on Thursday afternoons on Railroad Avenue.
In Hendersonville, 72 high‑risk families were identified. Twenty continue with adjusted home deliveries, while the rest are on weekly pickup schedules.
“We conducted a prioritization process. If someone has a car, we adjust schedules. But operating costs no longer support full routes,” Noreña said.
What is lost when a network collapses
The hardest part was delivering the news. “We had to call or message every farmer and supplier to say we could no longer purchase from them. Some had already planted for large July‑September orders and hired staff—it was devastating.”
That hidden—yet vital—local supply chain broke with the program’s end.
Impact Health’s economic analysis found that $75 million in spending generated $114 million in economic output and over $22 million in wages—with $74 million spent solely on food purchases.
Program termination didn’t merely cut a social service—it eliminated a direct income source for local producers.
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Beneficiary profile: structural reality
Many served families are led by mothers who don’t work, with fathers working long hours using the only household vehicle. “How are they supposed to get to the market? When?” asked Noreña. For them, Caja Solidaria also meant routine, connection, and support.
Approximately 50% of beneficiary families in both counties are Latino. “The name is Spanish because that’s how it started—but we serve everyone. We serve people of every color, size, flavor, and accent,” she said. “That’s why we always have bilingual staff.”
Despite challenges, the team persevered—returning to the 2020 solidarity model. “I’m betting on the power of community. On the collective love that exists in this town,” Noreña said.
Advocacy and policy response
In June, Caja Solidaria representatives traveled to Raleigh to meet legislators and explain the program’s scope and the impact of its loss. “Many weren’t even aware of the HOP pilot—some said, ‘If there are free food pantries, why not use those?’” Noreña recalled.
Such comparisons, she said, ignore dignity and fresh food principles maintained by Caja. “Everything is fresh, bought directly from farmers—people think it’s just charity, but there’s respect and purpose behind it.”
State Senate budget proposals included minimum funding to continue the program, but the House did not act on it.
In response to Enlace Latino NC, the North Carolina Department of Health and Human Services confirmed services ended on July 1, 2025 due to funding gaps.
However, the department publicly defended HOP’s efficacy: stating it “has proven to be a cost‑effective way to reduce medical expenses,” saving approximately $1,020 per person per year, while enhancing long‑term infrastructure linking health and social services.
“Our team stands ready to resume operations when funds are available,” they concluded.
Though funding could still be included in the final budget approved by the General Assembly, community organizations like Caja Solidaria remain uncertain.
Resilience through disaster
When Hurricane Helene struck western North Carolina in September 2024, Caja Solidaria was among the first to bring concrete aid to remote communities.
“Many of our families first saw me a week after the storm—with water, batteries, stoves, propane—because there was no internet, no phones,” Noreña recalled.
That experience shaped them. “We realized that in the end, we are a small community and must support one another. I’m betting on community strength. On what I saw after the hurricane. On this town’s collective love.”
PODCAST
Después de la tormenta
Hace un año, el huracán Helene golpeó al oeste de Carolina del Norte. La comunidad latina respondió con algo más fuerte que la tormenta: solidaridad.
🎧 En este episodio, conoce cómo las organizaciones latinas transformaron la crisis en resiliencia.
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