Inside Healthy Opportunities: Voices from the Pilot, Questions for the Budget - WNC Health Policy Podcast Ep. 11

PodcastMedicaid
Written By Soni Pitts
Boxes of food are stacked up in a food distribution center. NC HOP Medicaid Healthy Opportunities logo is overlayed in the upper left corner.

Photo credit: CHUTTERSNAP

The Healthy Opportunities Pilot, or HOP, is a program that uses Medicaid funding to address some upstream health issues like food access, transportation, housing, and interpersonal violence. By addressing these root issues, the program hopes to both improve health outcomes for North Carolinians, saving them and the state money. In the last budget, money was set aside to support this program. However, despite being approved last December and on the Governor's budget, the North Carolina General Assembly has removed HOP funding for the next two years, and the pilot programs like Impact Health are required to wind down their services, expecting a total shutdown by the end of the month, June 2025.

This raises an important question for North Carolina: What will the state be gaining or losing by removing HOP?

In this short series of the Western North Carolina Health Policy Initiative podcast, we'll be taking a look at this pilot program from a few perspectives to help educate our listeners and policymakers about what's on the table. In this installment, we hear about the impact of the HOP from the perspectives of the WNC network lead, a participating HSO, and two families with children enrolled.

Listen via the audio bar above, or via Apple Podcasts or Spotify

About the WNC Health Policy Podcast: In each installment, we speak about different public health strategies for improving health and well-being in Western North Carolina (WNC). The WNC HPl is a collaboration between the NC Center for Health & Wellness at UNCA and MAHEC, with generous support from the Dogwood Health Trust.

Individual opinions, findings, conclusions, or recommendations expressed in this podcast are those of the author(s)/interviewee(s) and do not necessarily reflect the view of the WNC Health Policy Initiative or its host institutions of the University of North Carolina Asheville (UNCA), Mountain Area Health Education Center (MAHEC) or our funders.


Transcript

AR: Andrew Rainey (WNC HPI)

JC: Jennifer Caldwell (Impact Health)

SJ: Sonya Jones (Caja Solidaria & the Henderson County Department of Public Health)

CS: Christina Schnabel (Caja Solidaria)

EJ: Elizabeth Johnson (parent advocate)

Resources:

INTRO

[Sound of a creek running]  

Sonya Jones: So if we were to imagine a scenario where there is no HOP, that's not only 10,000 people who are not receiving services, [and] all the farmers who put crops in the ground that now don't have markets to sell to, right. But it also means that just in Western North Carolina that the $11 million in savings that we realized for the Medicaid program are now lost, and we're going to actually spend that money on emergency medical services. 

[Banjo music]

Andrew Rainey: You are listening to the Western North Carolina Health Policy Initiative Podcast, a collaboration between the North Carolina Center for Health and Wellness at UNCA, and MAHEC, with generous support from the Dogwood Health Trust. I am Andrew Rainey. In each installment, we speak about different public health strategies for improving health and well-being in Western North Carolina. Recorded on the flickering Internet waves of mountainous Appalachia, in this installment we hear from multiple folks who are involved with the Healthy Opportunities Pilot being considered in the upcoming North Carolina budget.  

HOP SERIES RECAP

AR: Welcome back to the western North Carolina Health Policy Initiative podcast. In this series, we're looking at one health policy pilot that we learned about in the winter of 2023 to see how it's been playing out and let that inform listeners on what may happen as the program may be dropped in the upcoming budget for North Carolina. We're talking about the Healthy Opportunities Pilot. You can always listen back to Episode 6 of our podcast to hear a detailed breakdown of the program. But, in a nutshell: across 3 pilot regions, including Western North Carolina, each area has a network lead that works with local human service organizations to cover housing, food, transportation and issues related to interpersonal violence and toxic stress, for qualifying Medicaid members. The first of its kind to do at this scale, the rest of North Carolina and the rest of the nation are looking on to see what happens.  

In our last installment, we spoke to evaluator Seth Berkowitz, who let us know that after the initial spending to get the program running and eligible Medicaid recipients on board, the state is seeing approximately $85 per month per person saved for enrolled Medicaid members in HOP, suggesting that the pilot has been successful both at improving health and saving the state money.  

In this installment, we'll be speaking with some of the players on the ground, including the Western North Carolina Healthy Opportunities Pilot network lead, a participating human service organization, and the mother of a recipient of the pilot services. We hope that series will offer listeners the information you need to engage with health policy as it unfolds for Western North Carolina, whether you're a legislator, healthcare professional, academic, or local. Thanks for listening.  

 

ECONOMIC, HEALTH AND IMPACT OF THE HEALTHY OPPORTUNITIES PILOT

AR: We're here now with a sort of panel of folks involved in Western North Carolina's iteration of the Healthy Opportunities Pilot. Thanks everyone for joining me. Could I have you each introduce yourselves and your relationship to HOP? 

JC: Yes, I'm Jennifer Caldwell, and I'm the senior director of communications and community initiatives here at Impact Health. And we are the network lead for the Healthy Opportunities Pilot, which in a short version means our job is to work with amazing organizations like Caja Solidaria and make sure they have the resources they need to be successful in the pilot program. 

SJ: So I am Sonya Jones and I am the public health strategist for healthy living with the Henderson County Department of Public Health. Part of my role there is supporting all organizations that are seeking to increase access to healthy food, including the amazing work that's happening through healthy opportunities pilot. I'm also the founder and board member of Caja Solidaria, which you'll get to hear more about in a minute as one of the human service organizations that provide hot services in Henderson and Transylvania County. And I provide technical assistance to organizations across the state through the Food and Medicine Community of Practice. 

CS: Thanks, Andrew. My name is Christina Schnabel and I serve as the Co-Executive Director of Caja Solidaria. My connection to hope is personal and runs pretty deep. My son was one of the first participants to be enrolled in the program. I've engaged with the pilot in multiple ways, first as a recipient, then, as a staff member, and still now, as someone who gets to serve others through the work. So it's been a full circle journey for me and my family. 

EJ: I'm Elizabeth Johnson and I am the mother of a recipient of the Health Opportunities pilot. I have three children and my youngest is the one that's currently enrolled. 

AR: All right. Thanks everyone for being here, Sonia and Christina, as folks part of the human Service organization offering services for Medicaid recipients, could you give us some background on your organization and how you began to work with HOP? 

SJ: So Caja Solidaria was originally a produce buying club that started during the COVID-19 pandemic and this was a time when we were socially isolating and going into the grocery store felt scary and there were not always the kinds of foods we expected to find there. So people got really interested in cooperative purchasing and we were running that produce buying club. Out of our driveway and sourcing from local farms and food distributors, Elizabeth laughing because she remember the shed and the garage. And from there, Dionne Greenlee-Jones was giving presentations in our community via Zoom and really helping local organizations understand what Healthy Opportunities was and the incredible opportunity. But of course, a lot of local organizations were feeling stretched thin already by their services during COVID-19, and anxious about becoming a Medicaid service provider. So we really saw an opportunity to step in when other organizations were feeling stretched. Dionne-Greenlee Jones was a huge advocate for small organizations to be able to become a part of the Healthy Opportunities Pilot and she advocated for us to get some early capacity building funds to get us going. We continued to run out of my house for quite a while, but then we grew into two spaces across 2 counties, and I'll let Christina tell you a little bit more about that. 

CS: Yes. So we are currently serving over 350 families per week. The growth happened very, very fast. You know, I got to witness it grow from something very, very small to something that's very powerful.  

As far as Caja and how we're involved with hop, Caja is a collective led by people who have lived through food insecurity and health, and we offer living wage jobs focused on increasing access to healthy food, mainly through the Healthy Opportunities Pilot. Over the course of the past three years, we've delivered 3700 services to 566 people, and we're really just getting started. 

SJ: Early on, you know, [with] the capacity building funds, we were able to ask for the support through this to become a nonprofit organization, and there were some consultants early on that were able to step in and guide us around what would be the steps to be ready to become an HSO. And through every step in the process, Impact health was there to support us ,and the consulting organizations were there to support us, to move forward. So it was amazing in that way that they were able to take community, grassroots expertise and distributing food and help us grow into that HSO. 

 

AR: I know that Dionne, who talked to us on the podcast about HOP on a previous episode, was really a big part of getting this going. She passed away in January of this year, which is a huge loss for our region.  

It's cool to hear the impact of her work and helping get you all off the ground. The kind of work she was doing really set the example to get the results that Seth described in our last installment, where the initial investment shows both the health and financial payoff within the first year. From y'all's perspective, how do these results look on the ground to get enrolled and see an impact on health? 

CS: So for me it was word of mouth. Sonya is a really dear friend of mine when I was involved in the produce buying club - we purchased a half-share biweekly. And so, when she learned about the Healthy Opportunities Pilot, my son at the time was having gastrointestinal symptoms. And so I took him to the doctor, and the doctor prescribes him a fruit and veggie prescription. And so that's how we came to receiving services through HOP. And then within a few weeks of receiving the food, his gastrointestinal symptoms dissipated greatly. 

 

AR: OK. Cool. So, part of the program allowed doctors to write food prescriptions that gave us sort of formal pathway into accessing the needed nutritional support through HOP.  What was it like getting involved for you, Elizabeth? 

EJ: I was also peripherally involved in the food buying co-op, a little bit here and there. And then during the later days of the pandemic when things were starting to kind of open back up again, my youngest child missed 21 days of first grade, and I was at the doctor's office with her like constantly. And I think it was either through the doctor's office or my therapist - there was some community organization that was like, “Hey, what about this?” And they got us set up with home improvements with air quality and a high-quality vacuum - all stuff that was way out of our budget - and then the healthy foods box, as well, and an asthma diagnosis. And all of those things together, my child is finishing third grade and she's missed less than 10 days this year. 

 

AR: So for both of you and your families, having that stable access to fresh food and home safety interventions really had a notable impact. As you mentioned, clearing up GI issues and asthma, but also leading to other improved outcomes like in school with fewer days missed and loss of symptoms. It's interesting to hear how investment in nutrition through local farmers also leads to these other impacts like education and the economy.  

We heard some about this with Seth Berkowitz in the last episode, and it is an evidence-based pilot, but were you all surprised by the results of the program? 

JC: From the network lead perspective, we knew we were playing a long game and so although evaluation was built into the pilot, usually when you address these upstream social drivers of health, it takes a while to show that return. There's a more upfront cost, and then as health improves overtime you expect to see greater savings. And we know looking at other countries whose model is flipped, where they invest more in social care than medical care, their health outcomes are better. And so there is a financial savings to that investment.  

So yes, we were surprised to see, so early on, really.  At the point when that study was conducted, we had only been delivering services a little over a year at that point. So to see that early savings was a surprise. We all know anyone that's gone to the hospital or had an emergency room visit, the bills can be astronomical. And so of course it makes sense that making sure folks have healthy food in their refrigerator, in their pantry, and have a safe place to sleep, and can get to those resources that they need, have transportation support and support for moving into more healthy relationships. All of that is infinitely less costly in the long run, and is a net cost saving. And people are getting healthier in the process. It's a social win. It's a heart win and it's a pocketbook win. So we're really thrilled to see those results coming in so early. And we know those savings should only grow over time as people continue to get healthier. 

SJ: Yeah, I remember having a conversation with you early on, Jennifer, where I was like healthcare costs are not the story we should be telling. And here's why I think that's true: Because I'm out delivering food and I go visit my friend...let's say it's Joe, right? And I go visit Joe, and Joe tells me he's having heart palpitations. He's really worried about his heart. And nobody else is going to make Joe call the ambulance. But because I see Joe week after week, I'm like, “Joe, either you call or I call.” So I'm actually increasing healthcare costs because I'm paying attention when nobody else was before, and maybe no, Joe doesn't really regularly see other people.  

What Seth’s data shows is exactly Joe's story - that we had this peak in healthcare costs early on, an early investment right? And then those costs taper off so that we actually end up saving money because people are paying attention to what Joe needs over time and his diabetes is becoming more stable, and his anxiety is reduced. So we have the direct nutritional benefits of food boxes, but we have the much richer set of benefits that come with social care as well. 

JC: That's a great point, Sonia, and I think the other aspect that that lifts up is that managed care, well-managed health conditions, is much more cost effective and is much better for life outcomes and well-being to address those early on. So by Sonya noticing Joe's got an issue that if he addresses earlier on, it's not only going to be more likely to improve his health and his longevity, but it's also less costly than when Joe has a full-blown heart attack needing a quadruple bypass. That's a very expensive form of care and it doesn't improve quality of life or health outcomes. So that's another aspect of which kind of care do we want to pay for, and also that we are really targeting with the Healthy Opportunities Pilot folks who have complex health conditions.  

So right now it's not everybody on Medicaid, it's folks we know are already utilizing our healthcare systems, our emergency rooms, are getting hospitalized for things like asthma attacks. It's folks who can most benefit from this targeted social care support. And so that's another reason why we may be seeing the savings we are, is these are folks who already need help through Medicaid. We're going to be paying to support their care either way. So why not do it in a way that's optimal for our community members, our friends and neighbors and family members, and also that really makes financial good sense. 

 

AR: I'm really hearing that the impact of this program really echoes out beyond just the participants. 

JC: What's interesting is, like Sonia just mentioned, it's a real friend of hers. She gave him the name Joe, but that's a real friend. I have family members who are benefiting through HOP. If we really drill down, HOPis helping people, including our legislators, including our decision makers that they know this is the face of Western North Carolina. This is a program uniquely designed to support the reality of what many of our families are facing economically and with their health every day across our region. It's not somebody over there that, should we help them or not. It's our families, it's our friends, it's our neighbors. 

EJ: In the last three months, my husband has reversed his diabetes. And so, you know, even though he's not the one recipient, the supplements with the healthy food boxes have played a role and have helped our family broader. And I have many friends in the community that receive it. And the community aspect has been huge, because when I have a couple hours here and there, I'm able to go sometimes and volunteer just being able to be there for a couple hours and pitch in really helps my mental health. 

SJ: It is one of the really beautiful things about the design from the beginning is that we have known for a very long time that food insecurity is a household issue and you cannot address it at the individual level, right? So supporting the whole family is the way that you address all of these problems, and the whole family benefits. And when Elizabeth's husband's better off, so is the child who's referred initially. 

 

AR: Another aspect mentioned a little earlier is the power of social connection that has been occurring through the pilot. Could you speak some about how that impacts health? 

CS: With working our pickup market, for example, and people coming to Caja to pick up food and get to choose their selection, the connections that are taking place, the socialization, that is happening - we get to spend a substantial amount of time listening to people, to support, and that goes both ways, right? And that in of itself is a really, really beautiful thing to get to see happening. 

EJ: Yes, I can say like one of the things I most appreciate about Caja and the model that they use is the agency of being able to pick the things that we're going to use. And you don't feel like you're just getting a handout when you get to go in and choose what you're going to use for the week, you know. And my family, we always go in and I am careful to just choose what I know my children will eat, because I have autistic children and they don't eat all the things. And so we choose what they will eat. Two of my kids love to come with me because they want to pick the food and they also want to help. Like this has been such a huge thing for me, with my oldest child, who's 13 now and he struggles socially in a lot of ways. But he's been able to come with me and, like, help tear down boxes and help put apples out for people to get. And for him to learn what it is to be able to give back to the community a little bit has been huge for me with him and with my youngest daughter.  

And for my middle child who struggles to leave the house except for school, the couple of times that we had delivery delivered at the house, she came out of the house and she, like, was climbing in the van and be[ing] like, “What can I have out of here?” And so we'd let her pick her own fruit and her vegetable to try. And my kids [unclear] came to the market last week and she picked all the vegetables she would need to mix stir fry, and she went home and I helped her make stir fry. So it's helping me involve them in the preparation of their food, as well. 

SJ: And I just want to say that Caja was designed like this, this is an evidence-based approach. What we know is - the Surgeon General's report really explained this - but social isolation is the strongest social determinant of health. It's stronger than food, which you know as a nutritionist with a lifetime of work and food insecurity, it's hard for me to say that, but it is the most important social determinant of health. So everything that we do that builds community, not only addresses our mental health, but it reduces our chance of heart disease, it reduces our chance of diabetes, it reduces our chance of having cancer. Those social connections and community building opportunities are crucial to our health, and there's never been a time when we feel it so poignantly as we have after a pandemic and then a disaster. 

JC: Yeah, that's a great point, Sonya. One thing that is really brilliant about this approach as opposed to some other states, we're not the first person to try and their private health plans that are doing some social care support. There are other states that have tried their hand at it. We are certainly the most comprehensive in that initial set of 29 services across or domains 5, depending how you count it. We're definitely one of the most comprehensive. But the other thing that's really been impressive about this pilot and I think contributes to these health outcomes and early results is the focus on hyper-local service delivery. So that ends up benefiting our communities in multiple ways.  

One, just like Sonya and Christina and Elizabeth here showing, there was already a trusted local community partner, a place where people could gather and they trusted the service provision, the quality of the service is being provided. That was what this network model has tapped into is, who's already doing this work and doing it well? Who has the potential because of relationships in the community? That's something Dionne really knew and understood well in the early days of building our network was, who is trusted, who will someone let into their home because there are other relationships have been built prior to, and that's who we pulled into this network of care - those folks who knew how to do the work and knew their neighbors, and knew who needed help and how they could help them. And also, people who are committed to reinvesting those Medicaid dollars back into their community by supporting local farms and markets and contractors. So it's a ripple effect that benefits not only the ability to form community around the service, but also invest in community around these services. 

 

BREAK 

[Musical humming with cricket sounds in the background] 

AR: Hey there, this is Andrew. You're listening to the Western North Carolina HPI podcast, a show exploring health issues and policy impacting Western North Carolina. We're a production of the North Carolina Center for Health and Wellness at UNCA, and MAHEC, with funding from the Dogwood Health Trust.  

In today's installment, we're talking with a panel of folks connected to the western North Carolina network of the Healthy Opportunities Pilot to learn more about how it's been working, especially as it gets considered in the upcoming state budget. We'll return to the conversation in just a moment. 

[Musical humming with cricket sounds continues] 

AR: That was Asheville based Appalachian ballad singer Saro Lynch-Thomason humming the old shape-note-style ballad “Lady Margaret.” You can learn more about her work and regional music traditions at sarosings.com. And now back to the show.  

 

POLICY IMPACTS

AR: So before the break, we heard how Caja Solidaria, a human service organization, or HSO, with HOP got started and a number of ways it's supported health for folks involved, including some of the immediate health impacts of folks enrolled who are navigating complex health issues and their families. In the second half, we'll hear about other impacts in the community such as the economy and what could happen if HOP isn't included in the new state budget.  

So we got to hear some of the impact on individuals and their families. But Jennifer, from Impact Health’s perspective, could you speak some more about the larger impact on the community? 

JC: Yeah, I think that speaks to something that's also taking a longer lens on our region and some of the challenges that are endemic to living in Appalachia. We are, to generalize, a self-sufficient proud community. We have historically not had the same economic opportunities as more urban areas of the state, and people stay and they're committed to staying. Sometimes they have no choice but to stay. But we are a really proud set of mountain communities, that dignity and recognizing that dignity is at the forefront. And HOP is such an interesting program because it pulls in so many of the levers. I mean, poverty, access or lack of access to economic opportunity - that is the number one biggest health challenge that we have. And HOP really pulls on so many of those levers. It leans in on trusted community relationships. It uses Medicaid, which our region has a larger proportion of folks on Medicaid. So it finds an available mechanism to try and address more folks in our region. It prioritizes reinvestment in local economies. It produces jobs, not just for the organizations serving participants but all the vendors and contractors supplying services. So it's really tackling as many things as we can tackle in one pilot. It's just impressive. It's kind of the little pilot that's doing big things with local organizations who really care about, know and love their community members. That I think is built on that trust economy to have people who know the people they're serving to have evidence based evaluation tied to it to be starting from a point of, we know this works because it has been tested over and over again in other communities with many decades of research behind it.  

We were doing the very best, I think, the folks who designed this program to say this is a program you can trust, there is a strong evidence base behind every service being offered, and we're going to have it delivered not by some corporation that's outsourced to another state or another country, but folks in our communities living and working alongside the people they're serving. This is a trust based program and I think more than anything folks are not educated enough in Raleigh to know this is how it's working and those dollars are being very wisely invested, more so than many other programs that might be operating right now. And so we're hopeful we can build trust with folks who are in positions of putting things in budgets or taking them out of budgets, that it is a really fiscally smart investment in their local communities. 

 

AR: And for listeners who want to take a look at the evidence around this, you can listen to our previous installment with Seth Berkowitz and check out his and other evaluate his work to see specific figures. 

So funding for HOP was removed from the proposed budget of the governor by the General Assembly earlier this year, and since then we've seen a huge movement of support for HOP as the budget is being finalized this June, but haven't seen it yet added back in. Some have said that Medicaid has plenty of money now, to do what it needs to do with, I think what's a $500 million rebase. Can you speak some about the current allocation of Medicaid money? 

JC: That's a great question. And as I understand it, one of the problems we have is there's a gap of a couple $100 million in what they call the “rebase” or the base Medicaid budget. HOP could be prioritized under the existing budget, but the existing budget as proposed is less than North Carolina Medicaid and the Health and Human services Department say is necessary to carry out core functions as is. 

 

AR: So in addition to funding HOP, there would need to be more money going towards Medicaid to see the best results. Yes. 

JC: Yeah, I think the ask was $700 million. And so some of that also addresses some other priorities that the state has for programming. And of course we've also got the issue of, how do we support Western North Carolina that in the last year has really taken a tremendous hit in all fronts from Hurricane Helene is still in the early phases of recovery. 

 

AR: Yes. So the strategy of hop which addresses individual family and community health as well as economic investment could be thought of as a way to support our region through Helene. Would legislators need to write a specific line in the budget for it to get back in there as opposed to functioning under Medicaid in general? 

JC: A specific line item for HOP does protect HOP in terms of there is an allocated bucket of money set aside for the Healthy Opportunities Pilot. So there's some arguments back and forth whether HOP should just be part of business as usual and Medicaid, or whether it should be a carved out separate funding line item. But the clear concern that we would have is if North Carolina Medicaid doesn't have enough money to continue all of its services currently, then something's going to have to give. And so HOP could certainly be one of those things that has to give under that scenario. 

 

AR: What would happen if funding for HOP is not renewed? 

SJ: If we were to imagine a scenario where there is no HOP, that's not only 10,000 people who are not receiving services, all the farmers who put crops in the ground that now don't have markets to sell to, right. But it also means that just in Western North Carolina that the $11 million in savings that we realized for the Medicaid program are now lost and we're going to actually spend that money on emergency medical services. So all that we've learned is not actually being put into use. 

EJ: I think like without the Healthy Opportunities Pilot for my family, it means less community, less opportunities for me to get my kids involved in the greater community. I mean, even with SNAP benefits we can't feed a family of five on that, you know? So the food that we get each week definitely supplements our ability to eat well and to feed kids that struggle because of the way their brains work. We need that, you know, it's been a huge, huge help. 

CS: Without the Healthy Opportunities Pilot as of right this second, like my livelihood, is impacted. 

SJ: These are people's jobs, living wage jobs with great benefits. People have signed up to serve their community, to support their local farmers, to be deeply engaged in creating health and addressing social isolation. And those jobs would be gone. And across the network, it's more like 312 jobs would be lost and these are highly impactful long-term investments in people’s health and well-being. 

 

AR: Because this has been a pilot program and following the evaluation, a successful pilot program that is unlike anything done anywhere else, it seems like losing HOP is setting back some strategies the state has already invested a lot in already. 

SJ: If the Healthy Opportunities Pilot were to go away, it takes us in the opposite direction of all of the momentum. You know, private insurers like Blue Cross Blue Shield were doing experiments to see if it makes financial sense for them to be paying for food and medicine services, and they found that it did. They're working really hard with their analysts to figure out how much it would cost them to add in and be able to reimburse through private health insurance, and they're doing active experiments across the state around that right now. Other local insurers are really interested in making those kinds of investments. So Medicaid staying on track in North Carolina, really staying in the leadership is kind of crucial for what's already happening across the whole country. Like 19 different states have these waivers, and North Carolina is the focal point for the whole country for like how to do this well. And so what we really don't want to happen is for us to say, “Well, we did it well. Right now, we're done.” Right. 

JC: Yeah, that's a great point, too, Sonya. We are actively working with other states around the country who are looking to North Carolina as a leader in this approach, for a variety of reasons - for Medicaid programming and also for health plans who have a variety of people who engage with their services, through Medicaid, through private health insurance, and the programs they have to support their community, they're underinsured or uninsured. And I think from the social care space to be listed and featured in the Journal of [the] American Medical Association as an evidence-based practice. I mean, that's a real win for the other side of the house, the clinical side of the house, when we're talking about population health to recognize this is a really valuable intervention that we need to be adopting. 

SJ: Exactly. And the prestigious Health Affairs Policy Journal, right, comes out with a whole special issue on food-as-medicine and over half of the articles are about North Carolina and this nationally-relevant food-as-medicine journey. 

 

AR: Are there any takeaways that you all would like to leave listeners with before we sign off? 

JC: Investing in HOP is investing in our community, it's investing in our economy, it's investing in reducing spending that really doesn't help improve people's lives. It's crisis Band-Aid care that's terribly expensive. And so really, whatever angle you look at it, HOP is working, we have proof that it's working, and to not invest in that solution... 

You're investing in folks who are helping each other become more independent, more economically viable at the organizational level, at the business level, at the individual level. There’re kids in school, there're people able to return to work because they're not worried about their children or taking them to the emergency room several times a month to address unmanaged health conditions. That just having healthy food, having a clean mold free home, all the things that the pilot is designed to do. It’s really that long game. It's an investment in a much more affordable and healthy future at every level.  

And it aligns with the current administration's priorities. This is the way to make America healthy again. Food boxes [are] explicitly named in the Secretary of Health and Human Services recommendations. So it works. Let's keep doing it. Let's keep making an impact. 

SJ: And I hear a conversation around we want to make sure that people who can work are working, and actually the Healthy Opportunities Pilot is a really great way to help people maintain productive lives that invest in their communities. It's hard to work if you're sick. It's hard to maintain a job. If you're trying to manage multiple chronic health conditions. So, many Medicaid participants do work, and this supports their ability to continue doing that. 

 

AR: Well, Elizabeth, Christina, Sonya, and Jennifer - thank you all for coming on to the Western North Carolina Health Policy Initiative podcast to share about your experience with the Healthy Opportunities Pilot at each of the levels you're at. We hope that this offers our listeners a better vantage point into our states forthcoming health policies, whether as a legislator. Healthcare worker, academic or community member. Thanks again. 

JC: Thanks so much for the opportunity. Thank you. 

CS: Thank you, Andrew, thank you. 

[Soft jazz music]

OUTRO

AR:  You've been listening to the Western North Carolina Health Policy Initiative Podcast, a collaboration between the North Carolina Center for Health and Wellness at UNCA and MAHEC, with generous support of the Dogwood Health Trust. To listen again or learn more about public health issues in Western North Carolina, check out the website at wnchealthpolicy.org, or listen to more of our shows on Apple Podcast or Spotify.

If there's a Western North Carolina health issue that you'd like to hear more about, speak about or have comments about anything you've heard on an HP I podcast, feel free to send us an e-mail at info@wnchealthpolicy.org, or write a comment on wherever you listen to podcasts.

Another big thanks to Asheville-based Appalachian ballad singer Saro Lynch-Thomason, for humming the old shape-note-style ballad “Lady Margaret” in the mid-show break. You can learn more about her work and regional music traditions at sarosings.com. 

Other music in this podcast includes “Old Ballad” and “Little Margaret,” performed on banjo by Kath and Phil Tyler, found on the Free Music Archive, is licensed under an Attribution Non Commercial Share Alike 3.0 United States license. Additional music on the podcast included the track “Some Nights End” and “Night Watch” by the Blue Dot Sessions. These tracks are found on the Free Music Archive under license Attribution International CBY 4.0.

Remember that you can always reach out to your representatives in the House and Senate to offer your two cents on the future of health policy in North Carolina. During the month of June 2025, that includes the opportunity to amend or revise the budget during their legislative sessions. Be sure to check out the website for more HPI podcast episodes and other resources at wnchealthpolicy.org. Thanks for listening.

Connect with your elected leaders to express your views at the links below:

NC Senators

NC Representatives

NC Voting Maps

Soni Pitts
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Healthy Opportunities: Worth the Investment? WNC Health Policy Podcast Ep. 10