Part of the Food Policy Snapshot Series
Policy name: Medi-Cal coverage of Medically Tailored Meals
Overview: California’s Medicaid (Medi-Cal) health plans will offer and cover medically tailored meals for its members starting in 2022.
Population: 39.6 million
Food policy category: Nutrition, preventive health care
Program goals: One of the greatest challenges many people with complex disease states experience is attempting to change their diet as they face a variety of barriers, including affordability, food insecurity, food proximity, physical disability, and education around food as treatment or co-treatment. Medically tailored meals (MTMs) can enable these individuals to get past these barriers by providing meals directly to people that are tailored to meet their medical needs as assessed by doctors and registered dietitian nutritionists.
This program seeks to encourage the use of food as medicine, to improve nutrition, to address unmet social needs of Medicaid clients, and to help Medicaid clients avoid hospital- or nursing-facility admissions, discharge delays, and emergency-department use.
How it works: California’s Department of Health Care Services (DHCS) developed the CalAIM (California Advancing and Innovating Medi-Cal) initiative to improve the quality of life and health outcomes of Medi-Cal’s members. Under CalAIM, there are 14 approved In Lieu of Services (ILOS) components, including meals/medically tailored meals.
ILOS are appropriate and cost-effective alternatives to what is covered under Medi-Cal. It is optional for managed care plans to offer these services, and it is also optional for members to receive them.
Meals/medically tailored meals include:
- Meals delivered to a member’s home immediately following discharge from a hospital or nursing home.
- Meals provided to the member at home that meet the unique dietary needs required for treatment of chronic illness and are tailored to the member’s needs by a registered dietician or certified nutrition professional.
- Medically supportive food and nutrition services, including medically tailored groceries and healthy food vouchers.
Individuals who may benefit from this ILOS component include:
- Those with chronic conditions such as diabetes, stroke, cancer, HIV, cardiovascular disease, or behavioral health disorders,
- Those who have been discharged from a hospital or nursing facility with high risk of rehospitalization or nursing facility placement, and
- Those with extensive care-coordination needs.
Medi-Cal will cover up to three meals per day and/or medically supportive food and nutrition services for up to 12 weeks, or longer if medically necessary. Meals that are reimbursed by other programs are not eligible for coverage under Medi-Cal, and meals that solely address food insecurity will not be covered.
Some of the organizations that have been providing medically tailored meals for their communities for more than 30 years include God’s Love We Deliver in New York City, Community Servings in Boston, Project Angel Heart in Denver, and Ceres Community Project in northern California.
Progress to date: A proposal for CalAIM was released in October 2019 and final guidance was published on June 4, 2021. Coverage will go into effect in 2022.
Why it is important: Medically tailored meals are created to improve health outcomes, reduce healthcare costs, and improve patient satisfaction. Individuals living with chronic disease while struggling with social disparities such as poverty and food insecurity often have a hard time buying or preparing nutritious meals. Many health conditions can be improved or even cured with the proper diet, and it is important that a certified nutrition professional work with patients individually to determine their personal, medically tailored dietary needs.
One study conducted by MANNA (Metropolitan Area Neighborhood Nutrition Alliance), an organization that provides medically tailored meals in the Philadelphia area, found that clients’ healthcare costs were reduced by $10,764 per month in the first three months after receiving medically tailored meals. A different study from Massachusetts found that those receiving medically tailored meals had 50 percent fewer inpatient hospital admissions than those who did not receive meals. Similarly, Project Angel Heart reported that medically tailored meals were associated with a 13 percent decrease in hospital readmissions and a 24 percent reduction in medical costs.
Coverage of medically tailored meals will help individuals feel better and reduce the need for more costly medical services.
Program/Policy initiated: Coverage will begin on January 1, 2022.
Evaluation: Evaluation has not yet been conducted.
- California Food as Medicine Coalition (CALFIMC)
- Medically Tailored Meals Pilot Program (CA.gov)
- Health Insurers Are Beginning to Include Coverage for Healthy Foods. Could It Save Lives? (GoodRX)
- Improving Health Outcomes While Curbing Costs with Medically Tailored Meals (Center for Health Law and Policy Innovation)
- Meal Delivery Programs Reduce The Use Of Costly Health Care In Dually Eligible Medicare And Medicaid Beneficiaries (Health Affairs)
- With Payer Coverage, Food Is Medicine Movement Takes Flight (American Journal of Managed Care)
- Association Between Receipt of a Medically Tailored Meal Program and Health Care Use (Journal of the American Medical Association)
- CalAIM Enhanced Care Management and In Lieu of Services Frequently Asked Questions (FAQ) (State of California)
- California Advancing and Innovating Medi-Cal (CalAIM) Executive Summary and Summary of Changes (State of California)
- California Advancing & Innovating Medi-Cal (CalAIM) Proposal (State of California)
- Diet and Health Conditions (United States Department of Agriculture)
- Examining Health Care Costs Among MANNA Clients and a Comparison Group (Journal of Primary Care and Community Health)
- Fact Sheet – In Lieu of Services (ILOS) (State of California)
- Health-Related Services Brief (Oregon Health Authority)
- Healthy Opportunities Pilots Overview (North Carolina Department of Health and Human Services)
- MassHealth Accountable Care Organization Flexible Services (Commonwealth of Massachusetts)
- Medically Tailored Meal Delivery for Diabetes Patients with Food Insecurity: a Randomized Cross-over Trial (Journal of General Internal Medicine)
- The Medically Tailored Meal Intervention (Food is Medicine Coalition)
- New York State Medicaid Managed Care Alternative Services and Settings – In Lieu of Services (ILS) (New York State)
- Small Intervention, Big Impact: Health Care Cost Reductions Related to Medically Tailored Nutrition (Project Angel Heart)
- We Did it! Medically Tailored Food Becomes Covered Benefit in California (Ceres Community Proejct)