State leaders are using a wide range of strategies – from covering healthy meals under Medicaid to contracting for nutritious foods for prisons, state offices buildings, and hospitals – to reduce food insecurity and expand access to wholesome food. Last month, several governors proposed improving food access and nutrition by eliminating a grocery tax and increasing funding for food pantries and school meal programs.
The close relationship between food and well-being is borne out time and again by research showingdiet to be a major contributor to poor health in the United States, with diet-related disparities leading to poorer health among some racial and ethnic groups. But policy can make a difference.
Nutrition assistance programs, such as the Supplemental Nutrition Assistance Program (SNAP), have been associated with better health and education outcomes.
Programs that subsidize fruit and vegetable purchases have shown potential for reducing or avoiding health system costs while improving health.
As states invest in the social and economic conditions that affect health upstream, state policymakers have a range of opportunities to leverage their purchasing, contracting, and convening power to increase access to healthy food.
Medicaid Contracting Requirements
More states are requiring Medicaid managed care contractors to invest in the social factors affecting health, and healthy food policy is increasingly included in those efforts. For example:
Virginia’s Medicaid managed care contractors are required to address access to healthy foods, among other social determinants of health identified by the state Medicaid agency. At least one plan covers home-delivered meals for patients and family members for a limited time after discharge from a hospital.
Michiganrequires Medicaid managed care contractors to coordinate services and referrals for people who face challenges accessing food.
To improve health through healthy food access, states can:
Leverage their role as large purchasers by requiring healthy food purchasing from schools, hospitals, correctional facilities, and other state institutions. They can also encourage local governments to follow suit in their schools and communities.
Consider building reimbursement for evidence-based community nutrition, food-as-medicine, or medically tailored meal programs into state Medicaid plans and managed care contracts.
Use community benefit, hospital certificate of need, or licensing levers to require healthy foods in hospitals.
Align Medicaid, public health, and SNAP data collection and sharing to ensure that interventions seek to help individuals and communities with the greatest need.
Healthy Food Procurement
States negotiate contracts to purchase food for a variety of entities, such as corrections facilities and state hospitals. They also contract with vendors who sell food on state property, from state park snack bars to state office building vending machines. States can organize cross-agency efforts to build health and nutrition priorities into procurement across state government:
Through California’s State Food Procurement Work Group, the state department of general services, which negotiates food contracts, partnered with the California Department of Corrections and Rehabilitation (CDCR) to include nutrition standards in state contract requirements. This made it easier for CDCR to purchase, for example, some lower-sodium lunch options, according to a report by the California Health in All Policies Task Force, staffed by the state department of public health.
The New York State Department of Education partnered with the Department of Agriculture and Markets to issue guidance making additional reimbursement available to schools that spend at least 30 percent of their school lunch costs on foods that were grown, harvested, or produced in New York.
A number of states encourage or require healthier choices in vending machines located in state buildings. Washington’s Healthy Nutrition Guidelines set nutrition standards for food and drinks sold in state facilities, and an executive order called for a healthy food and beverage service policy for state employees that required healthy food and drinks in state vending machines, cafeterias, retail shops, and meetings and events.
Ending “Lunch Shaming” at School
After media coverage of some schools taking hot lunches away from children who could not pay for them or otherwise publicly identifying them, some states have passed statewide legislation to ensure access to school lunch:
In 2017, New Mexico enacted the Hunger-Free Students’ Bill of Rights Act, which prohibits schools from withholding meals from students who cannot pay for them, and from stigmatizing or publicly identifying such students.
In 2019, California enacted a law prohibiting schools from withholding meals from students unable to pay, and requires schools to “ensure that the pupil is not shamed or treated differently from other pupils.”
Healthy Food Prescriptions and Farmers Markets
Some healthy food prescription programs are designed to support local agriculture as well as improve nutrition, as there is someevidence associating farmers markets with increased fruit and vegetable consumption:
Washington State enacted legislation to establish a fruit and vegetable prescription program in which a health professional gives vouchers for fruits and vegetables to be purchased at a participating farmers market or grocery store.
Washington, DC’s Department of Health’s Produce Plus program gives participants up to $20 per week in credit to be spent at local farmers markets. The program is open to DC residents participating in Medicaid or a number of other programs.
Medically Tailored Meals
Several state Medicaid programs are treating food as medicine by paying for medically tailored meals for beneficiaries with certain health conditions:
Under New York’s Medicaid Value-Based Payment reforms, some Medicaid plans contract with a community-based organization to deliver medically tailored meals to people with life-threatening illness. The organization says it has reduced health care costs by 28 percent, compared to people with similar diagnoses who did not receive medically tailored meals.
A study of a Massachusetts program published in 2019 found that medically tailored meals were associated with fewer hospital admissions.
California’s Medi-Cal Medically Tailored Meals Pilot Program launched in eight counties in 2018. The program provides three meals a day for three months for people with congestive heart failure, and it will be evaluated to determine its impact on emergency room use, hospital readmission, and admission to long-term care facilities. Evaluation results are expected later this year.
MassachusettsS 2453 would require the state Executive Office of Health and Human Services to establish a Food and Health Pilot Program that would provide nutritious food subsidies and medically tailored food and meals to Medicaid enrollees. The bill would allow Medicaid accountable care organizations to participate as part of their flexible services
States can pass laws to require or encourage hospitals to offer healthier food to patients and staff, as encouraged by the American Medical Association’s resolution calling for hospitals to serve “a variety of healthy food, including plant-based meals” to patients, staff, and visitors. Hospitals can also leverage their community benefit or certificate/determination of need policies to encourage tax-exempt hospitals to invest in nutrition programs:
In 2018, California passed SB 1138, requiring hospitals and state prisons to make wholesome, plant-based meals available to patients and inmates. In 2019, New York passed SB S1471A, similarly requiring hospitals to offer patients plant-based meals and snacks at no additional cost to them.
As states work to improve health equity and control costs through healthy food initiatives, their accomplishments may encourage and align with health plan investments to improve the social determinants of health and reduce food insecurity, such as Kaiser Permanente’s Food for Life program and Solera Health’s investments in food security and other social determinants of health. On the national stage, some federal legislators are calling for greater attention to the social determinants of health. By continuing to work across agencies and with local and private partners, states can maximize their leverage to improve access to healthy food for all residents.
Produced in partnership with the de Beaumont Foundation. Thanks to Elinor Higgins, NASHP research analyst, for her contributions to this analysis.
https://nashp.org/wp-content/uploads/2020/02/nashp-food-governors.jpg8001200Melanie Felicianohttps://nashp.org/wp-content/uploads/2019/06/NASHP-Logo.pngMelanie Feliciano2020-02-18 13:01:572020-03-05 16:03:49States Are Advancing Healthy Food Policies in 2020