In western North Carolina, 13.3% of the population, nearly 130,000 people, lives in poverty, and nearly three in 10 households experienced food insecurity in 2024, according to the 2026 Regional Needs Assessment by Impact Health, an Asheville-based organization that serves the state’s western counties.
Until July 1, 2025, this same organization coordinated the Healthy Opportunities Pilots program (known as HOP) in the region. And HOP was designed precisely to help those families. Using Medicaid funding, it took a comprehensive approach to health and covered food, housing and transportation expenses.
This week, the North Carolina Department of Health and Human Services (NCDHHS) announced the program’s return on a smaller scale. HOP came to a halt when the General Assembly did not allocate funding for it in 2025. About 10,900 people in the region lost that support.
“It will be a smaller start. Healthy food boxes will be the first service to resume, and eligibility will be more limited,” Laurie Stradley, executive director of Impact Health, told Enlace Latino NC.
The new HOP budget consists of $9 million from the state, which, combined with federal funding, totals about $25 million. It is intended for the pilot program’s three regions (33 counties) and is expected to last six months, through June 2027, when lawmakers discuss the new budget.
“We are incredibly grateful that the General Assembly included funding for Healthy Opportunities,” Stradley said.
However, the funding comes nowhere near the amount the program had before its suspension. According to Impact Health’s executive director, it amounts to only “10% of what we initially requested.”
What does this return mean, and how will it affect a region where one in three residents is eligible for Medicaid and where poverty is higher among Latino and Black 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 healthy food boxes.
That is far less than what the region had during the previous phase. Between March 2022 and January 2025, HOP distributed 144,595 food boxes 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 an economic analysis by Impact Health.
The returning program, by contrast, will share $25 million among its three regions. NCDHHS anticipates that about 7,400 people could qualify in total, the agency told Enlace Latino NC.
“It’s a restart, but it’s almost a rebuilding,” Stradley said.
She means that having stopped running a program like this for more than 16 months and resuming it with a limited budget will have consequences for its implementation.
The difficult task of rebuilding trust
Impact Health does not yet know which organizations will participate. It is speaking with its former partners to explain how this phase will work and how much they will be reimbursed, and to ask whether they want to return.
Stradley knows it will not be easy for partners to trust again.
After HOP shut down, 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 back its delivery routes and tell farmers it could no longer buy from them.
That was just one case. Impact Health worked with more than 60 community partners through the pilot program.
“One of the most painful things, as an organizer and community leader, was feeling that we let these organizations down. We encouraged them to join this incredible pilot, but when it 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 broken trust at every level, from the state to our organization and further down, because we had not been able to maintain it,” Stradley said.
Stradley expects fewer organizations to participate in this phase because she still cannot assure them that the program will continue beyond June. She says she understands.
The need in western North Carolina
Food insecurity in the west varies widely 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 among which 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 gas in the tank to drive to the grocery store to buy it,” she said.
The program is returning as demand for food continues to rise. The MANNA FoodBank network now receives more than 220,000 visits a month across the 16 counties it serves, compared with 158,000 in 2023, according to its own records.
And more than 27% of rural households that turn to community organizations lost benefits in the past year, primarily from the Supplemental Nutrition Assistance Program (SNAP), according to a 2026 survey included in the assessment.
The program’s future after June
The program’s future depends on the funding it receives in next year’s state budget. Stradley hopes it will exceed the amount allocated for its return.
“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 health care. But it’s a very difficult time to do this,” Stradley said.
The strongest argument for this program’s success and necessity is tied to creating healthier communities. A study by the University of North Carolina found that participants made fewer emergency room visits and had fewer hospitalizations, and that HOP reduced health care costs by an average of $164 a month per person.
For Stradley, these communities also need a closer look.
“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, and find a way to be there and support those people, and do it with dignity,” she emphasized.
Implementation in the west
Families do not enroll directly through Impact Health. Care managers at Medicaid health plans verify whether a person qualifies and connect them with the community organization that will deliver the boxes.
Those who received HOP services before the suspension will not return automatically. They will have to undergo another assessment of nonmedical needs, just like those who are eligible for the first time, according to NCDHHS.
There is no start date yet. NCDHHS said it will notify organizations at least 30 days before deliveries begin, and Stradley noted that the state is talking about the “first part of the year.” The delay, she explained, is due to requirements related to the use of federal and state funds.
Once there is a date, Impact Health will spread the word through community organizations and community health workers. In the meantime, those who believe they qualify can ask 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 NCDHHS:
- Have a Medicaid health plan.
- Live in one of the program’s three regions. In the west, that includes 18 counties.
- Experience food insecurity.
- Be pregnant or have diabetes or cardiovascular disease.
- Because the boxes are delivered only to homes, additional requirements must also be met, such as being unable to get to a community meal site.
Those excluded include:
- In practice, nearly all children, because it is rare for them to have those conditions. “The most disappointing thing is that not many children are going to receive any of this,” Stradley said.
- Those who have only Emergency Medicaid, which covers only emergencies. This is the coverage available to immigrants who are ineligible for full Medicaid because of their immigration status, including undocumented immigrants.
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