New York’s newest Medicaid experiment is built on a simple premise: food and other basic needs can be powerful forms of medicine. Under a major Medicaid waiver approved by the federal government in 2024, the state is attempting to do something the U.S. health care system has rarely done—pay for interventions that address the social conditions driving disease. If the system proves effective, New York could help establish a national model for integrating food into health care.
The initiative, formally known as the New York Health Equity Reform (NYHER) amendment to the state’s Medicaid Section 1115 Waiver, authorizes more than $7 billion in federal funding through Medicaid’s Section 1115 waiver program to address health-related social needs such as food insecurity, housing instability, and transportation barriers. The program aims to reduce health disparities while lowering health care costs by addressing the root causes of disease. But translating that vision into practice is proving complicated. As the waiver has rolled out across the state, community organizations and policymakers are confronting one central challenge: whether the health care system can successfully deliver food as medicine at scale.
Addressing food insecurity through health care has been gaining attention as evidence that nutrition interventions can improve health outcomes mounts. A study published in JAMA Network Open estimated that if all eligible adults with diet-sensitive conditions received Medically Tailored Meals (MTMs), the United States could see roughly 1.6 million fewer hospitalizations and $13.6 billion in net health care savings in a single year. Studies like this have helped fuel a national “food as medicine” movement that seeks to integrate nutrition services directly into health care delivery.
In New York City, roughly 1.4 million residents are food insecure, meaning that they lack consistent access to enough nutritious food. Rates of food hardship rose in recent years as pandemic-era assistance programs expired and food prices climbed. And food insecurity is also closely linked to chronic disease, with low-income individuals who lack reliable access to healthy food and rely heavily on Medicaid facing higher risks for diabetes, hypertension, heart disease, and other diet-related conditions that are among the most expensive to treat.
New York’s Waiver represents one of the most ambitious attempts in the country to put the concept of food as medicine into practice. At the center of the initiative are newly created Social Care Networks, regional partnerships designed to connect health care providers with community-based organizations that deliver services addressing health-related social needs such as food insecurity, housing instability, and lack of transportation. Under this model, Medicaid patients can be screened during medical visits for food-related medical issues and then referred to approved providers offering services including Medically Tailored Meals, nutrition counseling, and produce prescriptions. The networks coordinate referrals and reimburse community organizations for delivering those services.
The structure attempts to bridge a longstanding divide between medical care and social services. Hospitals and clinics identify the need while community-based organizations deliver the support. In theory, this system could allow nutrition programs to reach a far greater number of patients. Natasha Pernicka, executive director of the New York State Food as Medicine Coalition, believes the Waiver could be a major step toward integrating nutrition services into mainstream health care. “The NYS Food as Medicine Coalition was formed out of the Food Pantries for the Capital District’s experience as a service provider under the DSRIP 1115 waiver, and starting a network of Food as Medicine grocery providers. New York’s food insecurity rate is higher than the national average. With food insecurity rates increasing in NYS, we are now at 1 in 7 people experiencing food insecurity, which includes 1 in 5 children. We believe strongly that consistent access to adequate nutrition is a critical point for health equity. Until we can scale food as medicine interventions equitably across the state, we will continue to struggle with health conditions that could be improved through nutrition security,” said Pernicka.
Yet building the system needed to deliver those services has proved challenging. And health policy experts say the complexity is not surprising, because integrating social services into health care delivery represents a major shift in the way Medicaid programs operate. In fact, New York Medicaid Director Amir Bassiri has acknowledged in a Politico article that setting up the system will take time as organizations build partnerships and operational infrastructure.
For community organizations, the transition into Medicaid reimbursement can be particularly complicated. Groups that historically focused on food delivery or nutrition education must now navigate eligibility verification, billing requirements, and data reporting systems designed primarily for medical providers. Policy analysts and nonprofit leaders have warned that these administrative demands may be especially difficult for smaller organizations with limited staff and financial reserves. Some non-profit providers operating on tight budgets will have to deliver services before reimbursement is processed, which could create cash-flow challenges for them. The process of building Social Care Networks has also slowed the initial rollout of the waiver in some regions, as organizations work to establish partnerships and operational procedures.
Beth Richardson, MPH, RDN, Food as Medicine Manager at the New York State Food as Medicine Coalition, says providers across the state are working through these challenges collectively. The Coalition runs monthly technical assistance groups for organizations participating in the 1115 waiver, including those who provide medically tailored meals, food prescriptions, and pantry stocking, to support problem-solving and shared learning.
Through these discussions, Richardson says, several consistent challenges have emerged. “Administrative burden and financial risk prevent smaller service providers from scaling,” she said, noting that providers often must conduct manual eligibility checks because a patient’s status can change between screening and service delivery, creating the risk of providing services without reimbursement.
She also emphasized that reimbursement structures remain difficult to navigate. Administrative payments often do not reflect the time required for detailed record-keeping, and unclear reimbursement tiers create ongoing financial uncertainty for providers. For programs that include meal delivery, additional logistical challenges—such as cold-chain requirements, mileage, and fluctuating gas prices—are not fully accounted for under current flat-rate reimbursement models.
“The heavy administrative burden and lack of clarity on reimbursement are barriers to scaling service,” Richardson said.
For organizations already operating at the intersection of food and health, the waiver represents both opportunity and uncertainty. New York City nonprofit God’s Love We Deliver, for example, has spent decades providing millions of medically tailored meals annually to people living with serious illnesses, including HIV/AIDS, cancer, diabetes, and heart disease.
“We have had a positive experience with the waiver and see the immense opportunity it provides to increase access to Food Is Medicine services,” said Eric Rochman, MPH, Chief Strategy & Growth Officer at God’s Love We Deliver. “The waiver expands on work we’ve been doing for 40 years and gives us the chance to reach more Medicaid beneficiaries and demonstrate the impact of addressing health-related social needs at scale.”
As a demonstration program, Rochman noted, the waiver was always expected to involve a learning curve, adding that state officials and Social Care Networks have been responsive to feedback as the system evolves.
Programs like these, which have helped to demonstrate that nutrition can improve health outcomes for patients with chronic illness, must now coordinate their services with hospitals and insurers, document patient eligibility, and navigate reimbursement structures that may be unfamiliar to those rooted in the nonprofit food sector.
Advocates say the waiver represents one of the most significant initiatives in the country. More than a dozen states have begun experimenting with providing nutrition benefits through Medicaid waivers, but New York’s program stands out for its scale, and, if successful, could demonstrate how addressing social needs, including food insecurity, can improve health outcomes while reducing health care costs.
But the long-term future of these initiatives remains uncertain. Section 1115 waivers are temporary demonstration programs–time-limited pilots authorized by the federal government–that require federal approval, and New York’s current waiver runs only through March 2027. Medicaid already represents one of the largest categories of government spending, and federal policymakers periodically propose changes that could reduce funding or tighten eligibility requirements. Analysts have warned that some proposed federal policy changes could cause hundreds of thousands of New Yorkers to lose their coverage, which would inevitably affect programs tied to Medicaid funding.
Despite those uncertainties, however, many advocates, including Pernicka and Richardson, see the waiver as an important step toward redefining how the health care system addresses chronic disease. For years, clinicians have recognized that medical treatment alone cannot fully address conditions like diabetes or heart disease if patients lack access to healthy food, and New York’s experiment is attempting to close that gap.
“Nutrition security demands attention and action through cross-sector collaboration between private, government, and non-profit sectors. Pernicka has said. The success of the waiver will depend on whether the infrastructure works for the organizations on the ground that are actually providing the food and nutrition services.
