“Food as Medicine” Gains Acceptance in State Legislatures

With America facing an obesity epidemic, it’s no wonder some are embracing the concept that food—simple, healthy, nutritious food—is medicine in and of itself, a philosophy that’s growing in popularity among health care providers.

The idea of “food as medicine” or “food is medicine” is hardly rocket science, although it is founded in science. Studies have found that tailoring meals for patients battling obesity or diabetes can have a tremendous, positive impact on their health.

These studies raise a couple of interesting policy questions: If food is indeed medicine, should doctors be able to prescribe it? And, more importantly, should health insurers have to pay for it?

Dr. Joshua A. Budhu, a neuro-oncologist and health equity researcher at Memorial Sloan Kettering Cancer Center in New York City, argued the affirmative to both questions in a recent opinion column for The Hill.

Budhu wrote that prescribing health foods “could prevent some 290,000 cardiac events and save almost $40 billion in health care costs for patients with diabetes. And those are only two groups of many who could benefit from easier access to healthy food.”

“Sadly,” he continued, “while insurance plans will cover prescription medications that cost thousands of dollars, they don’t cover something far more affordable and effective: access to healthy foods for patients who struggle to afford them. If our country is serious about improving health outcomes and lowering costs, we need to start treating food like medicine.”

State legislators across the country are beginning to heed Budhu’s call, introducing legislation to make food covered by state-run health plans or establish pilot programs to explore the idea.

Several Pending Proposals to Make Food Covered by Insurance

In California, AB 1975 by Assemblywoman Mia Bonta (D) would make “Medically supportive food and nutrition intervention” and “Medically tailored meals” or “MTM” a covered benefit under the state’s Medi-Cal program.

Back in 2022 the California Department of Health Care Services began offering community support services including medically tailored meals and groceries and food pharmacies. Bonta’s legislation would transition medically supportive food from an optional service under a waiver to a permanently covered benefit.

“Adequate food and nutrition are fundamental in preventing and treating chronic conditions, particularly among Californians of color who are disproportionately affected,” Bonta said in a press release announcing the bill’s introduction. “Making these interventions permanent would advance health equity by providing services to those impacted by diet-sensitive chronic conditions.”

In Illinois, HB 1529 would do something similar, amending the Medical Assistance Article of the Illinois Public Aid Code to provide—subject to federal approval—nutritional care services by a registered dietitian.

In New Jersey, AB 3512 would require state Medicaid and NJ FamilyCare to provide medically tailored nutritional services for certain enrollees of the programs.

In New York, AB 8584 would make medically tailored meals and other medical nutrition therapy to treat chronic diseases covered by insurance.

And in Rhode Island, SB 2592 would direct the state executive office of health and human services to launch a program to cover nutritional assistance and medically tailored meals.

“(T)hese kinds of health interventions help to bridge the siloes between healthcare and social and economic factors that impact one’s health,” said Whitney Francis, the Peter Harbage Fellow with the Western Center on Law & Poverty, in a recent post supporting efforts to have insurance cover food prescriptions in California.

Colorado Already Passed Bill Paving Way for Coverage of Medically Tailored Meals

 The bills mentioned above, in California, Illinois, New Jersey, New York and Rhode Island, are still pending. Their fates have not yet been decided.

 Colorado, however, has already passed legislation in this area this session. HB 1322, signed into law by Gov. Jared Polis (D) in early June, directs the state’s department of health care policy and financing to study the feasibility of seeking a federal 1115 Wavier so the Centennial State’s Medicaid program can pay for medically nutritious services, along with housing services.

 “With this law, we’re one step closer to securing additional federal funds to help with rental assistance, pantry stocking, and nutrition support that will strengthen our communities,” said Rep. Shannon Bird (D), one of the bill’s sponsors, in a press release after HB 1322 was signed into law. “Everyone deserves access to healthy, nutritious food and a roof over their heads. This law will help and uplift our most vulnerable neighbors, such as youth transitioning out of foster care or older adults seeking nutrition assistance.”

Rep. Kyle Brown (D), another of HB 1322’s sponsors, added, “By leveraging federal funds for nutrition and housing support, Colorado can help meet the diverse needs of families in our state. This law allows Colorado to access Medicaid funding for housing and nutrition programs for existing Medicaid patients, helping someone afford their rent or put food on the table. This law saves Coloradans money by leveraging federal dollars and ensures our most vulnerable neighbors are set up to thrive.”

Commercial Health Insurers Slow to Embrace Food is Medicine

The bulk of the activity related to the food is medicine movement has largely been confined to Medicare and Medicaid.

In Health Affairs, a leading journal on health policy, authors Ada Peters, Richard Hughes IV and Jeff Brown, write that while some innovative commercial health insurers are beginning to offer food is medicine, or FIM, benefits, “such as produce prescriptions and medically tailored groceries, to targeted populations,” the “vast majority” of commercial payers offer either no FIM benefits or only “home-delivered meals on a limited basis.”

The authors suggest a “novel approach” for policymakers to introduce FIM into commercial insurance: classifying “certain FIM interventions as preventive items and service under the framework established through Section 2713 of the Public Health Service Act, a prominent provision of the Affordable Care Act (Section 2713).” The FIM benefits would then have to be covered by most private health insurance plans without any out-of-pocket costs to consumers, such as copayments and deductibles.

That step, together with others like expanding coverage of FIM under Medicare and Medicaid and directing the IRS to issue new guidance clarifying that the use of FIM for the treatment of a specific diagnosis may be an eligible medical expense, could “make FIM a near universal health care benefit and help put the brakes on the US’s chronic disease epidemic,’ the authors conclude.

—By SNCJ Correspondent BRIAN JOSEPH

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