Part of the Food Policy Snapshot Series
Policy name: Arkansas Health and Opportunity for Me (ARHOME) Section 1115 Demonstration, MassHealth Section 1115 Demonstration, Oregon Health Plan (OHP) Section 1115 Demonstration
Overview: The Centers for Medicare and Medicaid Services (CMS) have given Arkansas, Massachusetts, and Oregon approval for Medicaid members to use benefits for food and nutrition services.
Location: Arkansas, Massachusetts, and Oregon
Arkansas: 3 million total, 1 million Medicaid plus CHIP (Children’s Health Insurance Program) members
Massachusetts: 7.2 million total, 2 million Medicaid plus CHIP members
Oregon: 4.4 million total, 1.4 million Medicaid plus CHIP members
Food policy category: Food access, food security, nutrition
Program goals: To allow low-income individuals greater access to healthy food and nutrition counseling.
How it works: Under the approved Medicaid waivers, these states will cover health-related social needs (HRSN) services for Medicaid beneficiaries. All three states cover nutrition counseling and education, including education about preparing healthy meals. Massachusetts and Oregon also cover medically-tailored meals, with up to three meals per day delivered to the home for up to six months, as well as fruit and vegetable prescriptions for up to six months, for eligible members. Massachusetts members may also be eligible to receive cooking supplies, such as pots and pans, if needed for healthy meal preparation.
Eligibility criteria for receiving HRSN services vary by state, but include having certain chronic health conditions that may benefit from a food as medicine approach to treatment.
States are required to report on program utilization and healthcare outcomes to determine their program’s effectiveness.
Progress to date: The state programs are directly aligned with the Biden-Harris Administration National Strategy on Hunger, Nutrition, and Health and the associated White House Conference on Hunger, Nutrition, and Health, which was held on September 28, 2022. All three states received CMS approval in the fall of 2022 and are currently piloting their programs with eligible beneficiaries.
Why it is important: According to the Center for Science in the Public Interest (CSPI), in the US each year 678,000 deaths are related to unhealthy diets and diet-related chronic illnesses such as heart disease, cancer, and type 2 diabetes. The Centers for Disease Control and Prevention (CDC) report that only 10 percent of American adults eat the recommended amount of fruits and vegetables, 90 percent of Americans eat too much sodium, and most Americans consume too much added sugar.
Nutritional interventions and condition-specific medically-tailored meals have the potential to improve health outcomes and reduce healthcare costs. Researchers at Tufts University have reported that more widely used medically-tailored meal interventions would save $13.6 billion per year in healthcare costs and prevent 1.6 million hospitalizations.
Medicaid members are generally low-income and, therefore, may not be able to afford the healthy foods they need. Programs that use insurance to cover nutrition services may help beneficiaries and the state to save money while the beneficiaries improve their health and nutrition status.
Program/Policy initiated: Massachusetts and Oregon received approval for their Section 1115 demonstrations on October 1, 2022, and Arkansas received approval on November 1, 2022.
Point of contact:
Health and Human Services Press Office
Similar practices: California’s Medi-Cal health plans began covering medically tailored meals in 2022.
Evaluation: Evaluations of the results have not yet been reported, but as these programs are being piloted on a time-limited basis, each state must monitor their program’s progress and report to CMS on the following metrics:
- Beneficiary participation
- Referrals to social services
- Financial expenditures
- Program successes and challenges
- Beneficiaries’ use of primary care services
- Beneficiaries’ use of more costly services, such as hospitalizations and emergency department visits.
- Addressing Health-Related Social Needs in Section 1115 Demonstrations (Centers for Medicare & Medicaid Services)
- CMS Approves Groundbreaking Section 1115 Demonstrations (The Commonwealth Fund)
- Federal Government Approves Oregon Medicaid Waiver, Including First-in-Nation Medicaid Funding for Food and Housing (Oregon Health Authority)
- Food as Medicine in Medicaid (American Action Forum)
- Food as Medicine? It’s Not as Simple as it Sounds. (The Washington Post)
- Medicaid Is a New Tool to Expand Healthy Food Access (Civil Eats)
- Several States Experiment with Putting Medicaid Funds toward Food (Marketplace)
- U.S. Begins Allowing Medicaid Money to Be Spent on Food (The Wall Street Journal)
- Adults Meeting Fruit and Vegetable Intake Recommendations — United States, 2019 (Centers for Disease Control and Prevention)
- Arkansas Health and Opportunity for Me Section 1115 Demonstration (Centers for Medicare & Medicaid Services)
- Biden Administration Allows Medicaid Funds to be Used to Pay for Groceries and Rent (Washington Examiner)
- Biden-Harris Administration National Strategy on Hunger, Nutrition, and Health (The White House)
- CalAIM Enhanced Care Management and In Lieu of Services Frequently Asked Questions (FAQ) (State of California—Health and Human Services Agency)
- Can Food Cure High Medical Bills? Pilot ‘Food as Medicine’ Programs Aim to Prove Just That. (USA Today)
- CMS Allows Medicaid to Address Unmet Social Needs (Axios)
- Food as Medicine (American Society for Nutrition)
- Fruits and Vegetables Serving Sizes Infographic (American Heart Association)
- GBD Compare (Institute for Health Metrics and Evaluation)
- Get the Facts: Added Sugars (Centers for Disease Control and Prevention)
- HHS Approves Arkansas’ Medicaid Waiver to Provide Medically Necessary Housing and Nutrition Support Services (U.S. Department of Health & Human Services)
- HHS Approves Groundbreaking Medicaid Initiatives in Massachusetts and Oregon (Centers for Medicare & Medicaid Services)
- MassHealth Medicaid and CHIP Section 1115 Demonstration (Centers for Medicare & Medicaid Services)
- Medicaid for Food Draws Mixed Reviews (Axios)
- The Medically Tailored Meal Intervention (Food is Medicine Coalition)
- Medically Tailored Meals Could Save U.S. Nearly $13.6 Billion Per Year (Tufts Now)
- Oregon Health Plan (OHP) (Centers for Medicare & Medicaid Services)
- Priority Nutrition Strategy: Fruit and Vegetable Voucher Incentives and Produce Prescriptions (Centers for Disease Control and Prevention)
- Sodium (Centers for Disease Control and Prevention)
- White House Conference on Hunger, Nutrition, and Health (U.S. Department of Health & Human Services)
- Why Good Nutrition is Important (Center for Science in the Public Interest)