Author: Lone Candle

“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.

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But the Healthy Opportunities Pilot shows the limits of such food-based interventions in public policy. These programs often require longer-term investments, chafing against the cost-cutting instincts that characterize Trump’s second term and legislatures in most red states — the policy level at which most MAHA ideas are put into practice.

In the case of HOP, the Joe Biden administration approved a Medicaid waiver last December to continue the program in North Carolina, which Gov. Josh Stein, a Democrat, hoped to expand throughout the state over the next two years. But in June, the Republican-led state legislature declined to fund it. State lawmakers argue the program costs more than it saves — a claim that state policy experts dispute because of the way Republican lawmakers were calculating the numbers. These experts say the long-term savings potential was given short shrift.”

https://www.politico.com/news/magazine/2025/11/08/healthy-opportunities-pilot-medicaid-north-carolina-maha-00626465