Evidence-Based Programs → Food is Medicine
Food is Medicine
Food is Medicine (FIM) initiatives offer a promising strategy to prevent and manage diet-related chronic diseases, including type 2 diabetes. FIM approaches help connect people to healthy foods to support the nutritional needs of those with diet-related chronic conditions. For state health departments working to increase enrollment and retention in the National Diabetes Prevention Program (National DPP) lifestyle change program, FIM initiatives can be a powerful complement to existing efforts.
This page provides an overview of FIM interventions, establishes a linkage between them and the National DPP lifestyle change program and DSMES programs, and summarizes examples of FIM interventions. The page is organized into the following sections:
- Definition and Overview
- Linking the National DPP Lifestyle Change Program to Food is Medicine Interventions
- Payment Options for Food is Medicine Interventions
- State Examples of Food is Medicine Interventions
See the Food is Medicine – Leveraging FIM to Support the National DPP Lifestyle Change Program Fact Sheet for a brief summary of this page’s content.
Definition and Overview
The U.S. Department of Health and Human Services (HHS) Office of Disease Prevention and Health Promotion describes FIM interventions as “encompassing a broad range of approaches that promote optimal health and reduce disease burden by providing nutritious food – with human services, education, and policy change, through collaboration at the nexus of health care and community.” FIM interventions are a growing part of federal and state strategies to address increasing rates of diet-related chronic conditions. FIM builds on broader food and nutrition programs like the Supplemental Nutritional Assistance Program (SNAP) and complements population-wide healthy food policies and programs to provide access to nutritious food as part of a patient’s treatment plan. These nutrition-based interventions range from providing medically tailored meals and groceries, to offering fruit and vegetable prescriptions, to nutrition education. These services are typically delivered through referrals from health care providers and are designed to provide access to specific foods to help people with or at risk for chronic conditions access the nutritious food they need to stay healthy as part of medical treatment.
HHS’ Office of Disease and Health Promotion has published the pyramid shown below that visually depicts the range of programs and interventions that make up FIM. The programs towards the base of the pyramid have broader, population-level impacts and are intended to reduce the severity of food insecurity and diet-related issues. The top of the pyramid includes programs for patients with greatest need, such as medically tailored meals and groceries. Individuals can access FIM interventions through various pathways, including within a clinical setting or through community access points (e.g., food banks, food pantries, social service providers) and state-based assistance programs.
While FIM interventions can also help address social needs like food insecurity, the programs at the top of the FIM pyramid have a primary goal that is clinical—supporting patients’ diet-related medical needs as part of a treatment plan.
Common FIM interventions include:
- Medically Tailored Meals – Meals tailored to a patient’s medical condition.
- Medically Tailored Groceries – Grocery boxes designed by a Registered Dietician (RD) to address patient’s specific dietary needs and health conditions.
- Produce Prescriptions – offer free or discounted produce to ambulatory patients based on a range of eligibility criteria, such as people who have a chronic condition, like diabetes, prediabetes, hypertension, obesity or heart disease, as well as people on low incomes and/or who are food insecure.
Linking the National DPP Lifestyle Change Program to Food is Medicine Interventions
FIM initiatives can serve as a referral source to connect eligible individuals to the National DPP lifestyle change program and as a program support to keep them involved throughout the program. State health departments and their partners can align FIM strategies with the National DPP lifestyle change program in the following ways:
- Identify and Enroll: Use FIM programs as a referral pipeline into the National DPP lifestyle change program. Individuals receiving medically tailored groceries or produce prescriptions may be more likely to meet National DPP lifestyle change program or DSMES eligibility criteria.
- Retention and Support: National DPP lifestyle change program participants may be more likely to stay engaged when FIM resources support their dietary changes. Access to healthy foods can reinforce the goals of the program. Lifestyle coaches could help program participants become aware of local FIM resources and encourage them to seek a referral to FIM programs from their health care provider.
- Enhance Clinical Referrals: Embed FIM and National DPP lifestyle change program referrals in electronic health records and provider workflows. This integration can streamline the referral process and increase the likelihood that eligible patients are connected to both nutrition support and evidence-based chronic disease prevention programs.
Leveraging State and National Health Initiatives
In 2022, the National Strategy on Hunger, Nutrition, and Health affirmed the importance of increased support for the prevention and management of type 2 diabetes and outlined several strategies that support state and local diabetes prevention efforts. One of the strategies outlined in the report was expanding access to FIM interventions for Medicaid and Medicare beneficiaries. The National Strategy supported the use of legislation and 1115 waivers to create pilot demonstrations to test the expansion of Medicaid coverage for these food-related supports.
Similar food-related program supports have been utilized in states such as Minnesota, Mississippi, and Virginia for Medicaid beneficiaries enrolled in the National DPP lifestyle change program.
Payment Options for Food is Medicine Interventions
As awareness and interest continues to grow across the country, states are exploring payment options for food and nutrition-related supports, including FIM interventions. The following are potential payment options for FIM interventions, many of which mirror the options available for the National DPP lifestyle change program and DSMES.
- Section 1115 Demonstration Pilots: Section 1115 Demonstration Waivers are intended to allow states to pilot new approaches to delivering Medicaid benefits. For more information on HRSN and 1115 waivers, see the Attaining Coverage through a Section 1115 Demonstration Waiver page here.
- Section 1915 Home and Community-Based Services (HCBS) Waivers: States may include nutrition supports in HCBS waivers for specific populations. These waivers are intended to develop programs to meet the needs of people who prefer to receive services in their home or community, rather than in an institutional or clinical setting. HCBS waivers include the following:
- In Lieu of Services (ILOS) under Managed Care: Under ILOS authority, Medicaid managed care plans can offer FIM services as substitutes for standard Medicaid services. ILOS must be cost-effective and medically appropriate. See how Michigan is covering nutrition services via Medicaid and ILOS here.
- Value-Added Services: In addition to ILOS, MCOs or other like-entities can offer additional services beyond those included in Medicaid contracts. These are termed value-added services and are another potential pathway used to integrate FIM into Medicaid managed care. MCOs can voluntarily offer FIM services that the state plan does not cover through value-added services.
For additional guidance, see:
- HHS: Select Policy Pathways for Food is Medicine Interventions
- Food is Medicine: A State Medicaid Policy Toolkit, 2024
- Centers for Medicare & Medicaid Services (CMS) Addressing Health-Related Social Needs in Section 1115 Demonstrations, 2022
State Examples of Food is Medicine Interventions
The tabbed table below explores examples of states that have integrated FIM interventions into their Medicaid programs.
California
California’s Advancing and Innovating Medi-Cal or “CalAIM” is a statewide initiative intended to transform California’s Medicaid program, also called Medi-Cal. CalAIM Community Supports are a component of the overall CalAIM initiative and are intended to “improve the overall health and well-being of Medi-Cal managed care plan (MCP) members by addressing members’ health-related social needs, help them live healthier lives, and avoid higher, costlier levels of care.” These include optional services that health plans can opt to provide in lieu of high-cost services traditionally covered by Medi-Cal.
In addition to supports such as housing transition and navigation services, housing deposits, personal care and homemaker services, and day habilitation programs, Medi-Cal offers medically supportive food/meals and medically-tailored meals to eligible members. Medi-Cal Managed Care Plans (MCPs) are encouraged to offer a range of food and nutrition options to members to address poor health outcomes associated with food insecurity, support complex care needs, support specialized dietary requirements, manage chronic conditions, and reduce hospitalizations. Services offered under this support include:
- Food delivered to home after hospitalization that meets unique dietary needs
- Help from a registered dietician or other professional
- Delivery of medically tailored groceries
- Healthy food vouchers
- Food pharmacies
- Behavioral, cooking, nutrition education
A pilot program supported by California’s Department of Health Care Services (DHCS), Project Angel Food, and Anthem informed the inclusion of medically supported meals as a CalAIM Community Support. The pilot focused on 252 patients with gestational diabetes, chronic heart failure, end-stage renal disease, and hypertension in Los Angeles, San Francisco, and Santa Clara Counties. Each participant received 14 meals per week for 13 weeks, in addition to receiving three nutritional counseling sessions. By the end of the 13 weeks, 35% of participants reported an improved quality of life, 87% reported maintaining or decreasing the hospitalizations, and 83% reported they maintained or improved their medication adherence.
Massachusetts
In May 2025, CMS approved Massachusetts’ 1115 demonstration waiver, which aims to test improvements in Medicaid coverage, access, and quality, while allowing the state to pilot benefits such as time-limited housing supports, clinical nutrition education, and medically-tailored food assistance services. While Massachusetts currently does not have Medicaid coverage of the National DPP lifestyle change program, this is an example of the type of services that could support National DPP lifestyle change program participants.
“Services authorized in this demonstration to address HRSN must be medically appropriate for the beneficiary.… The time-limited housing and nutritional support services authorized in the demonstration can be expected to stabilize the housing and nutritional circumstances of certain eligible Medicaid enrollees and thus increase the likelihood that they will keep receiving and benefiting from the Medicaid-covered services to which they are entitled.” (Demonstration Approval)
CMS also authorized Massachusetts to provide coverage for case management, outreach, and education, as well as infrastructure investments and transportation services to support health equity initiatives. The section 1115 waiver allows Massachusetts to receive federal Medicaid matching funds for specified demonstration expenditures. Additional information on Massachusetts’ 1115 waiver can be found here.
For additional information on 1115 waivers as they relate to coverage for the National DPP lifestyle change program, please visit the Attaining Coverage Through a Section 1115 Demonstration Waiver page of the Coverage Toolkit.
Oregon
In June 2024, CMS approved Oregon’s 1115 demonstration waiver, which provides opportunities to expand food and housing supports for Medicaid beneficiaries. Food and housing supports allowed under the new 1115 waiver include:
- Nutrition counseling and education, including healthy meal preparation
- Medically-tailored meals, up to three meals a day (up to six months)
- Meals or pantry stocking, up to three meals a day (up to six months)
- Fruit and vegetable prescriptions (up to six months)
The 1115 wavier allows Oregon to claim federal Medicaid matching funds for infrastructure investments to support the development and implementation of the above HRSN services. Through the waiver, federal Medicaid matching funds are also available to Oregon for technology, business or operational practices development, workforce development, outreach, education, and stakeholder convening. Additional information on Oregon’s 1115 waiver can be found here.
The National DPP lifestyle change program became a covered Medicaid benefit in Oregon effective January 2019 through the previous 1115 waiver and continues to be a covered benefit in the current waiver. Therefore, the food and housing supports now available in Oregon could apply to some individuals participating in the National DPP lifestyle change program.
For additional information on how Oregon’s 1115 waiver was used to achieve coverage of the National DPP lifestyle change program, please visit the Attaining Coverage Through a Section 1115 Demonstration Waiver page of the Coverage Toolkit.
