Medicaid Testing Food as Medicine Program in Some States – How Could It Affect Health?

Medicaid Testing Food as Medicine Program in Some States – How Could It Affect Health?

The Centers for Medicare and Medicaid Services (CMS) has begun testing a “food as medicine” program to respond to growing awareness that access to nutritious food promotes human health and interventions aimed at reducing health care costs. There is no uniform definition of “food as medicine”—and Medicaid pilot programs vary from state to state—but interventions may include food “recipes,” food safety or culinary training, meal delivery, and/or nutrition counseling.

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A new government initiative is taking steps to make the concept of “food as medicine” — the intersection of nutrition and disease prevention — a reality for Americans.

The Biden administration has begun approving applications in certain states for Medicaid to cover nutrition interventions to reduce health care costs. Select states – Massachusetts, Oregon, Arkansas and North Carolina – have initiated pilot programs to test the effectiveness of this type of coverage.

The Food as Medicine programs were created in response to the growing awareness that access to nutritious foods not only promotes human health but also increases healthcare utilization.

"Lack of stable housing and nutrition can impact the ability to enroll in health insurance and can negatively impact a person's health. This can lead to physical, social or emotional distress that fuels the cycle of health inequity," said a spokesperson for the Centers for Medicaid and Medicare Services (CMS).Health. “CMS-approved support services continue to test interventions that address the unmet health-related social needs – such as food insecurity – of eligible Medicaid members, while increasing the likelihood that they will continue to receive and benefit from services to which they are entitled.”

Here's a look at what the Medicaid food as medicine programs can offer and the long-term benefits they can create for individual and societal health.

What Food as Medicine Programs Can Offer

There is no consistent definition of “food as medicine,” and Medicaid pilot programs vary from state to state. Some states' coverage may include "prescriptions" for food, food safety or cooking education, meal delivery, and/or nutritional counseling as part of disease management or treatment.

In Arkansas, for example, an $85 million testing program was approved in November 2022 to provide nutritional counseling and healthy meal preparation to people ages 19 to 24 who are at risk for long-term poverty and poor health due to prior incarceration, foster care, or involvement in the juvenile justice system. Veterans at risk of homelessness, pregnant and postpartum women, and people with mental illness or substance abuse would also be eligible for nutrition services.

Other states will offer their own unique programs to support health through better nutrition. “In Oregon, they plan medically tailored meals, so think about healthy, balanced, nutritious meals like Meals on Wheels that are tailored to a person's specific health needs,” Akeiisa Coleman, MSW, senior program officer for Medicaid at the Commonwealth Fund, a national health care philanthropy foundation, said in an interview withHealth.

This might look like offering low-sugar and low-carb meals to someone with diabetes or low-sodium meals to someone with heart disease. Nutritional screening would ensure the accuracy of each person's meal plan, Coleman said, and would verify that the person meets other enrollment criteria such as age and level of food insecurity. “In Oregon, it’s really focused on youth with special needs and people experiencing homelessness,” Coleman added.

Similarly, Massachusetts' Medicaid program covers up to six months of home-delivered meals and grocery prescriptions for specific health conditions. These interventions are primarily intended for children and pregnant and postpartum women. North Carolina’s program, on the other hand, contains “recipes.” These vouchers are good for a specific dollar amount and can be used for fruits and vegetables that may be out of reach of low-income people.

As exciting as Medicaid nutrition programs sound, they can take time to implement. “Unfortunately, food-as-medicine services will not be available immediately, in part because they need to line up providers and complete some operational processes, such as informing providers of the newly available benefits and how they will work,” Coleman said. She believes the benefits will be available sometime in 2024.

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Are there any potential downsides to food as medicine programs?

The Medicaid programs represent a rethinking of healthcare. Instead of focusing only on treatment through traditional means (e.g. pharmaceuticals), these programs tend to focus on treatment and prevention through more nutritious eating habits.

But some critics believe the new programs exceed the limits of Medicaid and say other health services such as the Supplemental Nutrition Assistance Program (SNAP) and Women, Infants, and Children (WIC) already address nutritional needs.

Others foresee a possible conflict between patients' needs and providers' expectations. “We often hear the word ‘patient compliance’ about a patient’s ability to follow health care provider instructions,” said Clancy Harrison, MS, RDN, FAND, nutritionist, food justice advocate and host of the Food Dignity podcast.Health. “If registration of food as medicine is based on this outdated mindset that requires the patient to take primary responsibility for their disease management, it will fail.” Instead, she suggested that providers work with patients to determine how best to apply foods as medical benefits.

Additionally, Harrison warned that extremely specific dietary guidelines could create more problems than solutions for nonprofits, hospitals and food banks that provide food or meals to recipients.

“Paying more to meet strict dietary guidelines can put pressure on any food access organization that already has a very tight budget,” Harrison said. “Rigid nutritional requirements create more challenges and costs and set the nutrition as medicine program up for failure.”

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Potential Benefits of “Food as Medicine” Reporting.

Medicaid coverage of nutritious food for low-income people could result in major benefits at both the individual and societal levels.

“As food insecurity increases, so does the risk of 10 chronic diseases – high blood pressure, coronary artery disease (CHD), hepatitis, stroke, cancer, asthma, diabetes, arthritis, chronic obstructive pulmonary disease (COPD) and kidney disease,” Harrison said. "The ripple effect of untreated hunger extends beyond individual patients or even a local clinic. The associated health risks lead directly to higher healthcare costs for our entire country."

In fact, a 2017 study showed that food insecurity caused an additional $77.5 billion in health care spending in the United States. Ultimately, nutrition as medicine initiatives could reduce these numbers.

Because many Medicaid nutrition as medicine programs focus on children's nutrition, they could also improve health outcomes for children. “Food insecurity and food insecurity put children at risk of nutrient deficiencies, chronic disease, depression, anxiety and behavioral problems,” Harrison said. "All children need access to nutritious food to lead healthy, active lifestyles. A food-as-medicine program will protect our children's health and provide them with the nutrition they need to thrive."

As various states test Medicaid coverage for grocery prescriptions, meal deliveries, nutrition education and more, experts hope these services will eventually reach an even broader population or even be rolled out nationwide.

“We will likely see continued adoption of food as medicine approaches,” Coleman said, “as we see more benefits and improvements in health outcomes and cost savings associated with these programs.”