U.S. Begins Allowing Medicaid Money to Be Spent on Food

WASHINGTON—The Biden administration has started approving state requests to use Medicaid to pay for groceries and nutritional counseling as policy makers explore whether “food as medicine” programs can lead to broad health benefits and trim costs.

A growing body of research suggests that addressing food insecurity can improve health as well as deliver savings by reducing medical visits, the need for medication, or by helping control serious illness. The programs have also appealed to some GOP lawmakers who believe states should have more control over their Medicaid programs.

“This is something that is building momentum,” said Rachel Nuzum, senior vice president for federal and state health policy at the Commonwealth Fund, a national healthcare philanthropy.

Tapping medical funds for food programs has raised objections from some who say it is an unnecessary expansion of Medicaid. The Supplemental Nutrition Assistance Program, or SNAP, already helps people on lower incomes pay for food, these people say.

“This is really the first I’ve seen the federal government push food and air conditioners and other things as allowable. We already have the SNAP program,” said Gary D. Alexander, head of the Medicaid and Health Safety Net Initiative for Paragon Health Institute. “It seems like it’s blurring the lines,” he said.

While there is no formal definition, the idea of using food as medicine often takes the form of programs that deliver meals customized for specific medical needs to recently hospitalized patients, for example, or vouchers that would enable certain people to obtain healthy items such as  fruits and vegetables but not junk food.

In November, the U.S. Centers for Medicare and Medicaid Services approved a test program allowing Arkansas to spend up to $85 million in federal and state funds on health-related social needs, which include nutrition counseling and healthy-meal preparation. The agency approved similar demonstrations for Oregon and Massachusetts earlier last year.

The nutrition supports are part of a push by lawmakers in both parties, the federal government, and health providers who say providing lower-income people with better food, stable homes and adequate transportation can improve their health and avoid costly medical treatment.

“There needs to be a bigger emphasis on how do we start encouraging people to make good healthy choices,” which can help treat chronic diseases and reduce hospital readmissions, said Sen. Roger Marshall (R., Kan.), an obstetrician-gynecologist who has backed bipartisan legislation to establish a medically tailored meals pilot program under Medicare. “And that budget-wise is going to save us money in the long term.”

It is a marked change from treating beneficiaries solely with more-traditional medical services.  As a result, Medicaid in a handful of states is now paying for air conditioners to help with extreme heat, up to six months of rent and filtration devices that boost air quality.

The head of the U.S. Food and Drug Administration last month proposed creating a new nutrition center as part of a major reorganizationThe Agriculture Department is also boosting access to healthy food in nutrition programs it oversees. Agriculture Secretary Tom Vilsack noted recently that the agency funds “produce prescriptions,” which help participants buy fruits and vegetables.

Rep. Glenn Thompson (R., Pa.), who chairs the House Agriculture Committee, said the “food as medicine” concept has merit but needs study.

“In Washington sometimes, bright shiny things get a lot of attention and sometimes a lot of financial resources,” he said. “Let’s look at what the needs are.”

CMS didn’t return messages seeking comment. In a recent statement, CMS Administrator Chiquita Brooks-LaSure said the goal of such programs is to “better meet the health-related social needs of people with Medicaid coverage.”

Mindy Lipson, a director at Manatt Health, a professional-services firm, said specific programs states are looking at include nutritional counseling, medically tailored meals for enrollees with conditions such as diabetes, meals or pantry stocking for certain populations including children and pregnant women, and fruit, vegetable or protein boxes. 

About 11% of U.S. households didn’t have access to sufficient food or adequate quality food before the Covid-19 pandemic, according to an August 2021 report in Nutrition Journal. That rose to almost 15% during the pandemic, with a higher prevalence of more than 17% in households with children.

“Diet is the biggest risk to our health and the fact that it’s not integrated into healthcare delivery in this country in any meaningful way is shocking,” said Devon Klatell, managing director of the Rockefeller Foundation’s food initiative.

In October, researchers at Tufts University published an estimate that providing home-delivered, customized medically tailored meals could save roughly $13.6 billion a year after paying for the cost of food, with most of the savings in Medicare and Medicaid programs.

In Oregon, state officials got authorization last year to spend $1.1 billion in federal funds over five years to cover services for health-related social needs such as short-term food assistance. Eligible enrollees include youth in the child-welfare system, people released from incarceration or transitioning out of institutional care and people who are experiencing or at risk of homelessness.

The Medicaid-funded benefits will be available to eligible people in a phased implementation beginning next year.

 “We’re able to cover cooking classes and nutrition classes,” said James Schroeder, interim director of the Oregon Health Authority. “We can do up to six months of what we call ‘food and veggie RX.’ And up to six months of medically tailored meals.”

Arkansas’ Medicaid program got permission in November to spend Medicaid funding on nutritional services for people ages 19 through 24 who are at high risk for long-term poverty and poor health because they were previously incarcerated, in foster care or involved with the juvenile-justice system, as well as veterans ages 19 to 30 who are at high risk of homelessness.

Pregnant women and women who have recently given birth, and people dealing with mental illness or substance abuse are also eligible.

Massachusetts’  Medicaid program covers up to six months of home-delivered meals and medically tailored food prescriptions. The interventions, which include other social supports such as housing, are designed for specific populations such as children and pregnant women.

The concept of helping with meals and other social supports to improve health really took hold about five years ago, but at the time it was unclear whether it would be a fad, said Cindy Mann, a partner at Manatt Health.

“The clear answer now is that it isn’t,” said Ms. Mann. “It’s much more accepted and we see interest from states and providers.”

Now, she said, the interventions have been expanded, including for asthmatic children, pregnant women and underserved populations.

Commercial insurers and providers have yet to scale up these programs at the national level. Health and nutrition groups said early studies have indicated there is promise in deploying programs such as medically tailored meals or produce prescriptions, but that more research is needed to convince healthcare providers and insurers to incorporate these new ideas.

“Everybody embraces this in concept—and we have to find a way to pay for it within our businesses,” said Pam Schwartz, executive director of community health at Kaiser Permanente. “It’s a pivotal moment to explore how we can improve health and lower cost of care.”

Appeared in the February 13, 2023, print edition as ‘Medicaid Money Allowed to Buy Food’.