In early 2024, the Centers for Medicare & Medicaid Services (CMS) approved New York’s request to amend to its Medicaid Section 1115 waiver through a demonstration amendment called the Medicaid Redesign Team. As described in a previous article in the AmNews, this approval gives the Secretary of Health and Human Services (DHHS) the ability to waive parts of the Medicaid law, which in turn gives states such as New York the freedom to improve their current Medicaid programs, and approve pilot or “demonstration projects” that promote the objectives of Medicaid programs. One such project is Food as Medicine.
In an interview about the 1115 Waiver, the AmNews asked Amir Bassiri, Medicaid director for the New York State Department of Health (DOH), about the program. Bassiri said this is a topic he is “very passionate about…There are a subset of individuals, particularly those who are above the age of 65, and in a managed long-term care program—they could get Meals on Wheels type services…it’s very limited and they’re costly and we haven’t necessarily seen the uptake that we had originally hoped [for], which is what we think the waiver will really jump-start.”
According to Bassiri, “if you are an individual on Medicaid who may have chronic conditions, maybe suffering from substance use disorder, serious mental illness, or…pregnant, you would be eligible for a range of new food services, including weeks of groceries that would be eligible for Medicaid reimbursement; cooking supplies; …[they] could really benefit from food is medicine.”
According to Erika Hanson, clinical instructor with the Health Law and Policy Clinic and the Center for Health Law and Policy Innovation at the Harvard Law School, in an interview with the AmNews, “the 1115 waivers, and really all of the flexibilities in Medicaid in particular, are one of the biggest policy levers that we have right now to advance [food is medicine]…the White House releasing their National Strategy actually endorsed the use of Medicaid 1115 waivers to expand the use of food is medicine in prevention to address things like food insecurity…There’s a ton of momentum.”
Some of this momentum in Food as Medicine, according to Hanson, is a direct response to many of the disparities that were uncovered by the COVID-19 pandemic. The New York waiver proposal included discussion about the pandemic and food insecurity disparities by race and ethnicity, as well as diet-related chronic conditions like diabetes, with these chronic conditions being comorbidities for death during COVID-19. “ [It’s] waivers like this that connect folks to health-related social needs services like Food is Medicine…if there’s a pandemic [that] happens again, hopefully we’re in a better position where folks are not facing those extreme health inequities again.”
The authors of the article “Food is medicine: actions to integrate food and nutrition into healthcare” said that “[a] global epidemic of diet-related chronic disease has prompted experimentation using food as a formal part of patient care and treatment. One of every five deaths across the globe is attributable to suboptimal diet, more than any other risk factor including tobacco. Individual interactions with the healthcare system are an important opportunity to offer evidence based food and nutrition interventions.”
A wealth of research cited by the authors shows that food and nutrition interventions provided by the healthcare system can lead to increases in positive health outcomes for individuals, as well as lower healthcare costs and less actual use of healthcare services. The ultimate goal, according to the authors, is for a “healthcare system in which nutrition and food are a routine part of evidence-based disease prevention and treatment.”
Examples of these interventions include tailored meals, nutrient supplements, vitamins, and more. New York prepared for the passage of the 1115 waiver through a statewide project and then a coalition.
Hanson also said that research and interventions such as food is medicine have been shown to address health issues such as diabetes and high Body Mass Index (BMI), and reduce food insecurity, as well as being cost-effective. “The 1115 waiver that you see in New York…is really a great opportunity to expand a process to these services and also sustainably fund them,” Hanson said.
Many services attempting to combat such issues, according to Hanson, are funded through grants, but “the idea of funding through Medicaid…gives these social service organizations and these community-based organizations a chance for sustainability to grow and think about [being] permanent in the future.”
To learn more about the New York State Food as Medicine project, go to https://thefoodpantries.org/home/new-york-state-food-as-medicine-project/. To learn more about food policy work in the city of New York, go to NYC Food Policy: https://www.nyc.gov/site/foodpolicy/index.page.
This article has been edited for clarity and AmNews style.
I am all in on the food is medicine project. But, if we are not careful, this will become just another boon for manufacturers of processed food to slide their poison into sick people’s pantries and take over this program. They will hire slick marketers to advertise everything they sell as “food is medicine” and sick people will have their health destroyed compliments of the government. So the folk running this program need to be vigilant and ensure that the food is fresh and healthy.