She moved to Hendersonville to live in those mountains, but by 2022, Schnabel was struggling. She lived in public housing with her 6-year-old son, who suffered from a gastrointestinal issue. “I took him to the doctor, and he was prescribed a prescription food box,” she said.

Schnabel’s son was one of the first children to qualify for an innovative program in North Carolina called the Healthy Opportunities Pilot (HOP). The pilot served Medicaid-insured North Carolinians with chronic conditions by covering practical supports that affect health: fresh food, transportation to medical appointments, housing repairs and other services. These non-medical health solutions could reduce toxic stress and improve nutrition, housing, transportation and safety.

HOP paid for fresh food boxes, gas cards so that people could get to medical appointments and mold mitigation in homes, among other things. “It’s really about meeting a person as a whole person, not as a diagnosis, not as a social need,” said Laurie Stradley, CEO of Impact Health. “We were optimistic that we would see some positive movement in that first 18 months, but we were blown away by what we really saw.”

The results for Schnabel’s son were dramatic. Within weeks, his gastrointestinal problems eased. “When we received the boxes, my son did not need medicine to alleviate his symptoms,” Schnabel said.

She began to volunteer with Caja Solidaria, an organization providing healthy food to HOP participants in Western North Carolina. When the program expanded, she accepted a job with the nonprofit.

At Caja’s hub, Schnabel spins to show three sides of shelves filled with ripe avocados, oranges, carrots and peppers. “Back here is our ‘Food is Medicine’ market,” she said, showing the fresh produce that participants could pick up to help manage diet-related health conditions. “All of it is organic. All of it is as local and seasonal as possible. When the Healthy Opportunities Pilot was in service, people got to come grocery shopping here for free.”

Within two years of HOP, Caja Solidaria was serving 450 families. The investment in local food poured $2.5 million annually back into the local economy, supporting local farmers and businesses. Statewide, more than 400 farms sold into the program, which helped create 900 jobs.

Stradley of Impact Health thought HOP could shift health care dollars to help people live happier, healthier lives. But as the program continued, it did more than shift spending—it lowered it. By helping people manage chronic conditions and address everyday needs like nutrition, housing and transportation, the program reduced hospital visits, procedures and other costly care. Families and Medicaid both saw savings. 

Research published in the Journal of the American Medical Association found that HOP reduced health care spending by more than $1,000 annually per participant, providing evidence that addressing everyday conditions affecting health can lower medical costs. Another study pointed to the economic benefits that Schnabel experienced: each program dollar generated an additional $0.53 of economic activity, and HOP supported $36 million in wages. 

For families, those savings meant fewer medical crises and more opportunity. For the health system, it meant lower costs and a more efficient public investment in health care.

But these benefits weren’t enough to save this first-in-the-nation innovation. The North Carolina state legislature cut funding for HOP in 2025, sending farms skittering financially and organizations backpedaling their staffing and services, after building programs around the model.

Schnabel and the rest of the team at Caja Solidaria are not giving up. Today, Caja Solidaria is spreading the lessons learned from HOP through other partnerships, providing food prescriptions to people through insurance and medical providers and programs.

Practicing food as care, Caja continues to build connection and health through fresh, healthy food, rooted in the place that Schnabel fell in love with, where she chose to raise her family. “Our mission is to ensure that everyone has access to the abundance of our beautiful Southern mountains,” Schnabel said.