Medicaid Testing ‘Food as Medicine’ Program in Some States

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 requests in certain states for Medicaid to cover nutrition interventions aimed at reducing healthcare 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 have been instituted in response to a growing awareness that access to nutritious food not only supports human health, but also increases healthcare enrollment.

“Lack of stable housing and nutrition can impede the ability to enroll in healthcare coverage and can negatively impact the health of an individual. This can create physical, social, or emotional distress that fuels the cycle of health inequity,” a spokesperson for the Centers for Medicaid and Medicare Services (CMS) told Health. “The support services CMS has approved continue to test interventions that address the unmet health-related social needs—such as nutrition insecurity—of eligible Medicaid enrollees, along with increasing the likelihood they will keep receiving and benefitting from services to which they are entitled.”

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

There’s no single definition of “food as medicine,” and Medicaid’s pilot programs vary from state to state. Some states’ coverage may include food “prescriptions,” food safety or cooking education, meal delivery, and/or nutrition counseling as part of disease management or treatment.

In Arkansas, for example, an $85 million test program was approved in November 2022 to offer nutrition counseling and healthy meal preparation for people ages 19-24 at high risk for long-term poverty and poor health due to previous incarceration, foster care placement, or involvement with 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 diet. “In Oregon, they’re planning medically tailored meals, so think healthy, balanced, nutritious meals like Meals on Wheels tailored to someone’s specific health needs,” Akeiisa Coleman, MSW, Senior Program Officer for Medicaid at The Commonwealth Fund, a national healthcare philanthropy foundation, said in an interview with Health.

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

Similarly, Massachusetts’ Medicaid program will cover up to six months of home-delivered meals and food prescriptions for unique health conditions. These interventions are intended primarily for children and pregnant and postpartum women. North Carolina’s program, meanwhile, features produce “prescriptions.” These vouchers are good for a certain dollar amount, usable for fruits and vegetables that may be out of reach for low-income people.

As exciting as Medicaid’s food as medicine programs sound, they may take some time to implement. “Unfortunately, the food as medicine services won’t be immediately available, partially because they have to get providers lined up and do some operational processing like informing providers about the newly available benefit and how it will work,” Coleman said. She believes the benefits will become available sometime in 2024.

The Medicaid programs represent a shift in thinking about healthcare. Rather than focusing on treatment only via traditional means (such as pharmaceuticals), these programs lean toward treatment and prevention through more nutritious dietary choices.

But some critics feel the new programs overstep Medicaid’s bounds, saying other health services like the Supplemental Nutrition Assistance Program (SNAP) and Women, Infants, and Children (WIC) already provide for dietary needs.

Others foresee a potential clash between patient needs and provider expectations. “We often hear the words ‘patient compliance’ about a patient’s ability to follow what the healthcare provider asked them to do,” dietitian, food equity advocate, and host of the Food Dignity podcast Clancy Harrison, MS, RDN, FAND, told Health. “If food as medicine enrollment is based on this outdated mindset that requires the patient to be primarily responsible for their disease management, it will fail.” Instead, she suggested providers work with patients to determine how to best apply food as medicine benefits. 

Additionally, Harrison cautioned that extremely specific nutritional guidelines could create more problems than solutions for nonprofits, hospitals, and food banks that provide recipients with groceries or meals.

“Paying extra to meet strict nutritional guidelines can squeeze any food access organization that is already on a very tight budget,” Harrison said. “Rigid nutritional requirements create more challenges and costs, setting the food as medicine program up for failure.”

Medicaid’s coverage of nutritious food for low-income people could lead to major benefits on both an individual and societal level.

“As the severity of food insecurity increases, so does the risk of 10 chronic diseases—hypertension, coronary heart disease (CHD), hepatitis, stroke, cancer, asthma, diabetes, arthritis, chronic obstructive pulmonary disease (COPD), and kidney disease,” said Harrison. “The ripple effect of untreated hunger goes beyond individual patients or even one local clinic. The associated health risks translate directly to higher health care costs for our entire country.”

In fact, a 2017 study showed that food insecurity contributed an additional $77.5 billion in healthcare expenditure in the U.S. Ultimately, food as medicine initiatives could reduce these numbers.

Because many Medicaid food as medicine programs focus on childhood nutrition, they could also improve health outcomes for kids. “Food insecurity and nutrition insecurity puts children at risk for nutrient deficiency, chronic disease, depression, anxiety, and behavioral problems,” Harrison said. “All children need access to nourishing food to live a healthy and active lifestyle. A food as medicine program will protect the health of our children and provide the nourishment they need to thrive.” 

As various states pilot Medicaid coverage for food prescriptions, meal delivery, nutrition education, and more, experts are hopeful that these services might eventually reach an even wider population—or even be implemented nationwide.

“We’ll likely see continued adoption of food as medicine approaches,” Coleman said, “as we see more benefits and improvements in health outcomes and cost savings related to those programs.”