Biden administration allows Medicaid funds to be used to pay for groceries and rent
Abigail Adcox
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Several states are using the Medicaid program as a tool to address food insecurity with the approval of the Biden administration, directing funding to pay for groceries and offer nutritional counseling.
Arkansas, Massachusetts, Arizona, and Oregon have all recently been approved to use funding from the public health insurance program for low-income residents toward initiatives addressing food access and nutrition issues, as early research suggests that reducing food insecurity could decrease the need for doctors visits and lower overall healthcare costs.
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“This is part of a broader recognition that 70% of health outcomes are attributed to things that happen outside of the doctor’s office. So that includes the social drivers, like your access to food, like your employment, your community connections, your housing,” said Rachel Nuzum, the senior vice president for federal and state health policy at the Commonwealth Fund, a healthcare philanthropy. “This isn’t, you know, Medicaid morphing into a grocery supplier for everyone. It’s a very targeted approach.”
The Biden administration encouraged more states to apply for Section 1115 waivers earlier this year that address “unmet health-related social needs, such as housing instability and food insecurity.” The waivers give states an avenue to test new initiatives using Medicaid funding.
Critics of the recent approvals have argued that it is an unnecessary expansion of Medicaid, pointing to existing federal programs, such as the Supplemental Nutrition Assistance Program that helps low-income people buy food. Gary Alexander, the head of the Medicaid and health safety net initiative for the Paragon Health Institute, told the Wall Street Journal that this is the first example of the “federal government push food and air conditioners and other things as allowable.”
Last September, Oregon’s Medicaid program got approved to spend $1.1 billion to offer food and housing assistance for up to six months to marginalized groups, including youth in foster care, low-income adults, and people who are homeless, according to an announcement by the Oregon Department of Health. It also is going toward buying new air conditioners and air filters.
Massachusetts also received expanded authority last year to provide clinical nutrition education and medically tailored food assistance services for people, such as postpartum women, for up to 12 months. The state’s Medicaid program will also provide meal support for some households when an eligible beneficiary is a child or pregnant woman with special clinical needs.
States are required to apply for the waivers under established parameters that require the initiatives to be cost-effective and medically appropriate in order to qualify, according to the Centers for Medicare & Medicaid Services. The waivers have been granted for over 50 years since Medicaid was set up, but they were relatively small in scope until the early 1990s, when states began to use them to expand eligibility and change benefits, among other things, according to the Commonwealth Fund.
Presidential administrations have had different approaches to what they would like to see the waivers used for. Under the Trump administration, states were encouraged to apply for waivers to make employment or volunteer work a requirement for Medicaid eligibility.
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Some limited studies have indicated that medically tailored meals and other social supports could be successful in improving health outcomes. A report from the Friedman School of Nutrition Science and Policy at Tufts University found last year that adopting more programs that make and deliver medically tailored meals for people with diet-sensitive diseases could lead to fewer hospitalizations nationally and save roughly $13.6 billion yearly.
“The interventions of providing food and the interventions of providing affordable, stable housing, how essential those are, not just for people to live a high quality life, but for them to achieve their health outcomes, right, because it’s really difficult to achieve adherence to a medication if you have an empty stomach or if you don’t have a safe place to store it or refrigerate it,” Nuzum said.