New Harvard and Tufts University analysis examines an accelerating pathway to integrating nutrition with healthcare
February 20, 2024 (Cambridge, MA) — Poor nutrition is a direct determinant of health, the leading driver of mortality in the U.S., and costs an estimated $1.1 trillion annually. This disproportionately affects people based on socioeconomics, race, ethnicity, geography, and disability. While federal law does not explicitly provide for food as a Medicaid benefit, the Centers for Medicare & Medicaid Services (CMS) and states have recently been exploring ways to integrate nutrition into health care benefits.
“The Evolution and Scope of Medicaid Section 1115 Demonstrations to Address Nutrition: A U.S. Survey,” published in Health Affairs Scholar, systematically analyzes the scope and utilization of one major new pathway: State Medicaid Section 1115 demonstration waivers. The study finds the use of these demonstration waivers by US states has accelerated in pace, scope, and population coverage since 2021, with major implications for diet-related health and health equity in the U.S.
“There is no question that nutrition impacts health outcomes and that poor nutrition can have grave consequences for individuals and communities, increase health care costs and decrease economic productivity,” said Erika Hanson from the Center for Health Law and Policy Innovation of Harvard Law School and the article’s lead author. “Our analysis shows meaningful advances in states’ use of Medicaid Section 1115 demonstration waivers to incorporate nutrition services into health care, with lessons for clinicians, health systems, and payers eager for potential solutions to long-standing problems.”
Medicaid is the nation’s health insurance program for Americans who have low-income or are disabled, covering nearly 90 million Americans across all 50 states and DC. Medicaid Section 1115 demonstration waivers allow states to pilot coverage for non-traditional services like “Food is Medicine” (FIM) services – treatments like medically tailored meals, medically tailored groceries, and produce prescriptions – designed to address nutrition needs of patients with diet-sensitive diseases. However, the extent of utilization of these state waivers and the scope, types of interventions, and target populations of this health care tool had before now remained undefined.
This investigation fills this gap by evaluating the evolution and current landscape of states’ Medicaid Section 1115 demonstration waivers used to provide coverage of nutrition services, including types of interventions and populations covered, and implications for patients, health care providers, and Medicaid programs.
“Our findings show remarkable acceleration of states’ interest in testing new approaches to improve health in Medicaid, with 19 states now having nutrition-related 1115 waiver programming, including 11 states since just 2021,” said Dariush Mozaffarian, director of the Food is Medicine Institute at the Friedman School of Nutrition Science and Policy at Tufts University and senior author of the study. “The increased interest in nutrition has also been accompanied by a greater scope of services, in particular Food is Medicine interventions which 7 states have incorporated into their demonstrations since 2021 alone.”
These trends are relevant to clinicians, health systems, and payers who need to understand in which states food and nutrition screening is required or covered, which Medicaid beneficiaries are eligible for nutrition interventions, how to refer beneficiaries to these new services, and how to bill Medicaid for care. These developments also require meaningful infrastructure changes and investment from health systems, and integration into medical education.
“Moving forward, our findings also highlight the need for rigorous, independent evaluation of these demonstrations’ impact on health, health disparities, health care spending, and health care system design,” said Katie Garfield, Director of Whole Person Care at the Center for Health Law and Policy Innovation at the Harvard Law School.
This research was supported by a grant to Tufts University from the National Heart, Lung, and Blood Institute, National Institutes of Health (R01HL115189).
The article was authored by:
Erika Hanson, J.D., Center for Health Law and Policy Innovation, Harvard Law School
Daniel Albert-Rozenberg, Center for Health Law and Policy Innovation, Harvard Law School
Kathryn M. Garfield, JD, Center for Health Law and Policy Innovation, Harvard Law School
Emily Broad Leib, JD, Center for Health Law and Policy Innovation, Harvard Law School
Ronit A. Ridberg, PhD, MS, Food is Medicine Institute, Friedman School of Nutrition Science & Policy, Tufts University
Kurt Hager, PhD, MS, Instructor of Population & Quantitative Health Sciences at UMass Chan Medical School
Dariush Mozaffarian, MD, DrPH, Food is Medicine Institute, Friedman School of Nutrition Science and Policy, Tufts University; Tufts University School of Medicine and Division of Cardiology; Tufts Medical Center
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About the Harvard Center for Health Law and Policy Innovation
The Center for Health Law and Policy Innovation (CHLPI) advocates for legal, regulatory, and policy reforms in health and food systems, with a focus on the health, public health, and food needs of systemically marginalized individuals. CHLPI’s broad range of initiatives aim to expand access to high-quality health care and nutritious, affordable food; to reduce health- and food-related disparities; to develop community advocacy capacity; and, to promote more equitable, sustainable and effective health care and food systems. To learn more, please click here.
About the Food is Medicine Institute at the Friedman School of Nutrition Science and Policy at Tufts University
The Food is Medicine Institute is a university-wide collaborative effort based at the Friedman School of Nutrition Science and Policy, bringing together Tufts University experts from across disciplines with other local and national collaborators to advance Food is Medicine (FIM) research, training, patient care, and community and policy engagement. Tufts is the leading academic institution globally for advancing FIM, engaging in multiple large FIM interventional trials in collaboration with health care systems, extensive policy and comparative effectiveness analysis, and more. The first-of-its-kind Institute serves as a catalyst to drive change, improve health, reduce health disparities, and create a more equitable and resilient health care system that recognizes the power of nourishing food. To learn more, please click here.
About UMass Chan Medical School
UMass Chan Medical School, one of five campuses of the University of Massachusetts system, comprises the T.H. Chan School of Medicine, the Morningside Graduate School of Biomedical Sciences, the Tan Chingfen Graduate School of Nursing, ForHealth Consulting of UMass Chan Medical School and MassBiologics. At UMass Chan, we are advancing together to improve the health and wellness of our diverse communities throughout Massachusetts and across the world by leading and innovating in education, research, health care delivery and public service. UMass Chan is perennially ranked in the top 10 percent of medical schools for primary care education and among the top 50 medical schools in the nation for biomedical research funding. Learn more at www.umassmed.edu.
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