New Medicaid benefit for some Michigan patients: Better food

• New flexibility in Medicaid rules allows states to cover services beyond traditional medication and therapies
• Some states have begun to cover things like mobile crisis units or chiropractor appointments
• In Michigan, the focus is on healthy food

About 1.7 million Michiganders may soon be eligible for free home-delivered meals and fresh produce.

Beginning in 2025, health insurers providing Medicaid coverage in Michigan have more flexibility in providing doctor-ordered, healthy food through an effort called “in lieu of services,” or ILOS.

The flexibility is made possible by an update last year to federal rules that allow state Medicaid programs to cover services that substitute for other care and are considered medically appropriate and cost effective. And it reflects the Biden administration’s focus on addressing “social determinants of health” — housing affordability, transportation, access to healthy foods, and walkable communities and clean air, for example.

While not traditionally seen as health care, those everyday realities of where people live, work, and socialize dramatically impact health and well-being — possibly much more than clinical care itself.

The change in rules could allow health providers to better address their patients’ housing instability or — in Michigan’s case — food or nutrition insecurity.

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Dr. Mehmet Oz, President-elect Donald Trump’s pick to lead the U.S. Centers for Medicare and Medicaid Services, also has promoted a “food as medicine” approach to health. And Robert F. Kennedy Jr., Trump’s choice to head the US Department of Health and Human Services, has vowed to fight a food industry that he says is driving America’s obesity rates.

The state’s managed-care providers can now offer better nutrition to patients in four ways:

• Medically tailored home delivered meals: This benefit includes initial evaluation with a certified nutrition professional, such as a registered dietitian or nutritionist, and home-delivered meals designed to address specific health conditions.
• Healthy Home Delivered Meals: These nutritionally balanced, home-delivered meals are formulated to improve nutrition, in general, for patients
• Healthy Food Pack: These assortments of medically tailored or nutritionally appropriate foods primarily will be offered for pick-up — at food pantries or through community groups, for example.
• Produce Prescription: These vouchers for fruits, vegetables — or plants and seeds that produce fruits and vegetables — can be used at farmer’s markets and grocery stores.

In theory, helping patients improve their diets will help shave health costs in the long run. 

For example, low-income, diabetic Michiganders often rely on more affordable, but high-sodium, highly processed, packaged food that leads to spikes in blood sugar levels. Theoretically, healthier food provided through their insurance plan will help reduce the odds of acute health crises that arise from blood sugars that spiral out of control, said Katie Commey, manager of strategic engagement and planning at the Michigan Department of Health and Human Services.

In a study published earlier this month that pulled from 30 years of research data from nearly 203,000 men and women, researchers at the T.H. Chan School of Public Health at Harvard University found that diets rich in plant protein may reduce risk of cardiovascular disease by 28% and coronary heart disease by 36% over diets poor in overall protein. Moreover, replacing red and processed meat with plant sources, such as nuts, lowered risk of stroke, according to research published Dec. 2 in the American Journal of Clinical Nutrition.

A ‘heavy lift’ for insurers

But nutritious food is costly. Just how much is complicated, but one oft-quoted study — now more than a decade old — estimated that it costs $1.50 more a day to eat healthy. A more recent study put the additional cost of eating a “nutritionally sound diet” at $627 a month for a family of four with two adults, a child aged 8 to 11 and another aged 12 to 17.

That puts fresh food far out of reach for many Michiganders. That’s also true for those with no transportation to reach stores with fresh food, said Dr. Peter Chang, a family medicine physician and CEO of Battle Creek-based Grace Health.

“People are going to dollar stores and convenience stores to get milk and eggs, and (those places) don't carry fresh fruits and vegetables,” he said.

The clinic embraced a “food as medicine” model in 2020, opening a food pantry for patients with funding from the Michigan Health Endowment Fund. Doctors at Grace now can offer patients fresh food for pick-up three days a week through a partnership with the South Michigan Food Bank, which stocks the food.

It’s crucial, though, to make sure patients consume them, Chang said.

“You don't just deliver food or make the food available,” Chang said. 

Doctors refer patients to a lifestyle counselor or the dietitian, who not only offer recipes but ask pointed questions: Does the patient have pans to cook with?”  Knives to prepare the food? Spices to make the food tasty?

That Medicaid may now be able to incorporate fresh foods in their managed care offerings is “huge,” he said.

“Health is very complex — it's not just one thing. It's not just fresh vegetables, but that’s a key component,” he said.

Still, insurers have been slow to embrace the Medicaid flexibility that has been available since 2016, said Elizabeth “Libby” Hinton, a Medicaid expert with KFF, a San Diego-based health care research organization.

The new rules released in January, 2023, clarified the program, she said.

But they also come with strict guidelines and reporting requirements that might delay broader implementation, said Tiffany Stone, deputy director of government programs at the Michigan Association of Health Plans.

Some insurers for years had incorporated fresh food or addressed other social determinants of health in their managed care Medicaid plans — believing it to improve quality of life and health for members, she said.

“Now it's so prescriptive,” Stone said. “Trying to navigate all of the guardrails” is a “pretty heavy lift.” 

While the new flexibility is effective Jan. 1, she said consumers may not see the first offerings until spring.