In Edneyville, North Carolina,  a food box is more than just meals. “It was a blessing,” said Vastine Allen.

Allen works hard to care for her family. She takes her fiance to chemo and radiation treatment appointments and cares for her grandbabies—ages 19, 17, 14, 12 and 5—while her daughters travel for nursing work.

She loves to cook and take her grandbabies fishing for bass, crappies and catfish in Osceola Lake and Lake Lure. ”I love every minute with them,” she said. “They keep you up on your toes. And we dance a lot.”

For Allen and thousands of other Medicaid recipients, North Carolina’s Healthy Opportunities Pilot (HOP) made it possible to address everyday barriers that shape health: food, housing, transportation, and safety.

In practice, that meant meeting people where they were and addressing what actually stood between them and better health. “We could talk to them,” Allen said. “They’d call and check on us to see how we was doing. I miss that, because it was very helpful. I definitely miss the fruit and them boxes.”

Allen’s experience reflected what providers across the state were seeing. The innovative, first-in-the-nation HOP program reaped results. Health care costs for participants declined by an average of $85 per month, with greater savings the longer the participant stayed in the program.

“I would vouch for that,” Allen said of improved health after participation in HOP. Another study found that each program dollar generated an additional $0.53 of economic activity and that HOP supported $36 million in wages.

The program started in 2022. Over three years, providers and participants got to know each other 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. “They were so friendly,” Allen said. “They were very caring for people.”

In Allen’s case, HOP delivered weekly food boxes delivered to her doorstep. “Meat and vegetables,” Allen said. “The vegetables were excellent. Onions, potatoes, native apples, oranges, bananas and grapes. And it was good. Everything was.” Reliable access to fresh food helped participants manage their health day to day, reducing the need for emergency care.

HOP supplemented the nutritious food Allen grows in her own garden—green beans, okra, corn, tomatoes, peppers, lettuce, cauliflower and cucumbers. She freezes and cans as much as she can, but it never lasts long with hungry youngsters around. 

Allen appreciated having choice in nutritious, quality food. “The food boxes was tremendous,” she said. “They come right in, on time. It helps a lot of people that can’t get out, and they deliver the stuff to you, and they let you choose what you want and don’t want. And they had a good quality of stuff.”

After Hurricane Helene, HOP helped pay for repairs in Allen’s home, including energy-efficient lighting, safer wiring in the home and water improvements. It also provided gas cards so Allen could travel to medical appointments in Hendersonville. Together, those supports allowed Allen to stay safely housed and keep up with medical care, the kind of coordination that’s hard to achieve through health care alone.

This summer, the North Carolina General Assembly withdrew funding for HOP, abruptly shuttering a social safety net that was lifting people up rather than trying to catch them when they fell. “I don’t even know why they took the program away,” Allen said. “I wish it was still here, because people get benefits from it.”

Allen lives on Social Security Disability benefits in North Carolina’s “LIttle Apple Country.” She raised her kids here on Stoney Creek Road, also known as “Little Rocky” and “Windy Road.”

“I’ve been here over 30 years, and I just love the place,” Allen said. “It’s quiet, very quiet, peaceful. It’s a laid-back community.”

Now, Allen is celebrating. Her daughters both had recent birthdays, and Allen cooked a mouth-watering lasagna. She’s looking forward to her anniversary with her fiance April 18, as well as ringing the bell on the last of his cancer treatments.

Allen wants to find a way that HOP can continue. Even after the program ended, Allen keeps thinking about what made it work, and how similar support could help others in her community. 

“There’s some way we should be able to get this program started back up, at least to help the elderly out, because it came in handy for them, and for everybody,” she said. “I’m down to help get it up and running. At least we could get some support that we need.”