. . .

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.

Within three weeks of this change in diet, his symptoms cleared up. Schnabel began volunteering with Caja Solidaria, the mutual aid group that distributes local produce to people in need, including her son. She’s now their co-executive director, earning a wage that has allowed her to buy her own home and health insurance. “This program changed my life,” Schnabel said. “It gave me exactly what I needed: fair access to healthy food, meaningful work and a real chance to build a better life.”

. . .

For Republican legislators in North Carolina, neither the calculations from these studies nor such unquantifiable benefits were enough to convince them to save the program.

. . .

But in Washington, enthusiasm for programs like HOP appears to be waning. In March, the Centers for Medicare & Medicaid Services, which HHS oversees, removed federal guidance encouraging states to apply for the kind of Medicaid waivers that allowed states flexibility in how they used federal money and, as in the case of HOP, allowed them to use it to provide nutritious food for low-income families.