On his first route driving for Interfaith Assistance Ministries (IAM), fresh off a job selling shoes in Hendersonville, Russell Layson saw parts of North Carolina he never knew existed. “It was such a wild experience,” he said. “These tough roads, the long driveways. You’re out in the middle of nowhere.”

GPS didn’t always work. Neither did cell service. And nobody wants to get a large van full of fresh food stuck in the mud. “It was a little nerve-wracking at first,” Layson said. “We’ve got some boonies around here. If you don’t know where you’re going, you just have to pray you’re on the right road.”

Working for IAM, Layson drove fresh, nutritious food to about 70 households in Polk, Transylvania, and Rutherford counties in Western North Carolina. The boxes overflowed with oranges, lemons, potatoes, onions, lettuce, pineapple, berries, cucumbers, celery, sweet potatoes, supplemented by nutritious dry-food staples like pasta, rice, trail mix and peanut butter. The program expanded to include meat, with neighbors getting to choose what they wanted.

But this work—funded through North Carolina’s Healthy Opportunities Pilot (HOP)—was more than a food box. For Layson’s neighbors and for thousands of other Medicaid recipients with significant social and physical needs, the innovative, first-in-the-nation HOP program broke down everyday barriers that impact health: food, housing, transportation and safety.

“They essentially got a prescription for this nutritious food,” said Interfaith Ministry Assistance human resources and development director Bethany Duke. “That was what the medical professionals and insurance companies were trying and testing.”

Over three years, starting in 2023, providers like Layson got to know his neighbors through regular interactions, learning what people needed to improve their health, whether that was removing black mold from a home, socializing, trying new recipes with fresh vegetables or getting people to doctor’s appointments. Through HOP, IAM could provide assistance with rent, utilities and transportation, including gas cards and referrals for home repairs.

Layson saw how the program changes perspectives and possibilities for North Carolinians. “I started noticing the houses were getting cleaned up more, and I started seeing the positives in their mentality,” he said.

The groundbreaking program led to real health improvements. Health care costs for participants declined by more than $1,000 per year, with greater savings the longer the participant stayed in the program. Another study found that each program dollar generated an additional $0.53 of economic activity and supported $36 million in wages.

Fresh food might be its own prescription, but the program also shared with every North Carolina neighbor a human touch, an opportunity to check in and build human connection. “That was the coolest part about it,” Layson said. “You have conversations and get to know them. We became so close, just making deliveries.” Some even said they looked at Layson as a family member.

Layson always brought dog treats, and he learned the back stories of his neighbors. A farming couple shared fresh produce from their garden and invited him into the house. They told Layson that their weekly interactions together had encouraged them to “start looking at life a different way” and “start giving people a chance.”

But in the summer of 2025, the North Carolina General Assembly abruptly withdrew funding for HOP, crushing a social safety web that was reducing costs and increasing economic activity.

Eliminating HOP cut a third of the Interfaith Assistance Ministry staff. It was a heart-wrenching time for the IAM team, who grieved both the loss of workplace community and the regular, supportive relationships they’d built with their neighbors. 

One of the neighbors started tearing up when learning it would be Layson’s last delivery to her home. “He’s practically the only interaction I get,” she told Layson’s wife Allison. “He’s just such a blast to talk to.”

She invited them to return to visit her and her dog, anytime. “This program helped me more than anything,” she said.

Layson now has a position as a retail manager for IAM, but he still grieves the loss of work that made such a big, positive impact on people’s lives.

“There’s so much evidence and proof that the program works,” Duke said of HOP. “We would love to have it back. Our neighbors, our staff, we all believe in this program, past and future tense.”