Massachusetts lawmakers want to know: What happens when Medicaid recipients get healthy food as part of their healthcare?
The answer might sound obvious and even tautological—newsflash: healthy eating makes people healthier—but Democratic state senator Julian Cyr and house representative Denise Garlick want details. So this week they introduced a first-of-its-kind bill that would establish a pilot program to give individualized nutrition services—including meals, groceries, or grocery money—to residents enrolled in Medicaid and then measure the impact of doing so on people’s well-being and the state’s bottom line.
“If you look at the amount of dollars that we spend on healthcare in Massachusetts, we spent over $60 billion last year,” Cyr said in a phone interview, referring to a finding in a recent state report on the expenditures through Medicaid, Medicare, and private insurance.
MassHealth, the state- and federally funded Medicaid program that provides health insurance to low-income Massachusetts residents, spent $17 billion on health care in 2018. The program has varying eligibility thresholds for residents, based on factors including age, disability, and family size. A family of four must earn under $34,248 per year to qualify.
Before becoming a legislator, Cyr worked at the state department of public health. Inspired by the local food initiatives taking hold in his district, which includes Cape Cod, Martha’s Vineyard, and Nantucket, he says he wanted to know how centering nutrition in the healthcare system would affect people statewide. He teamed up with Rep. Garlick, who also has a background in nursing and public health, to sponsor the legislation in the house. (Garlick didn’t respond to requests for comment.)
Food as medicine is an age-old idea—some people speculate that Greek physician Hippocrates was a proponent of the approach—that has gained popularity in the American medical system in recent years. Today, plenty of localities fund programs to give food stamp users with specific health needs money to spend at farmers’ markets. A California hospital is piloting a program that places doctors in grocery stores to guide shoppers towards healthier purchases. And the state of California itself is currently experimenting with delivering pre-made meals to people with congestive heart failure.
These examples illuminate the wide scope that medically tailored nutrition can encompass. The proposed pilot program in Massachusetts would include all of the following: pre-made meals, pre-selected groceries, and money for nutritious foods. The range speaks to the various and specific needs that patients have. For example, people with relatively severe health issues, such as congestive heart failure, type 2 diabetes, and kidney disease, might receive pre-made meals delivered to their homes, while those with high blood pressure or pre-diabetes might get subsidies to use at the grocery store.
“There are different populations that are in need of different nutrition interventions,” explains Sarah Downer, an associate director and law instructor at Harvard Law School’s health law and policy clinic. She says that pre-made and delivery meals “are really for people who have […] trouble shopping and cooking for themselves—it’s not the right nutrition intervention for everyone.”
“This [pilot program] would look at the efficacy of a suite of those services, the ability to triage individuals and find the correct service for them, link them to it, and then see what the impact is on utilization and costs across the board.”
Downer led the research team that recently published a comprehensive report on the potential benefits that food can have on the Massachusetts health care system, which in turn informed the development of this proposed legislation. The report highlighted a range of findings linking nutrition with health. In a 2019 study of over 1,000 participants, for example, pre-made and delivered meals were correlated to a halving of inpatient hospital admissions and a 16 percent reduction in health care costs.
The exact details of the pilot program still need to be hammered out. As it stands, implementation would be guided by a commission of public health officials, medical experts, and representatives of nonprofit health care organizations. By incorporating nutrition into the daily lives of MassHealth recipients, the state—which devoted nearly a quarter of its budget to the program last year—also stands to benefit economically.
As mentioned above, it feels increasingly redundant to spout how healthy eating can benefit health. Massachusetts lawmakers appear to have decided that it’s time to calculate just how valuable that benefit is.