July 27, 2023

The Case for More Coverage: How Medicaid Guidelines Impact our Understanding of Food as Medicine

Whether you’re a client, volunteer, donor, or other member of the MANNA community, you may know that many MANNA clients are among the more than three million Pennsylvanians who receive healthcare through Medicaid, the jointly funded federal-state health insurance program for low-income populations. But, did you know an increasing number of our clients receive their MANNA meals through their insurance provider? In fact, MANNA was one of the first nonprofits to partner with insurance payers to secure reimbursement for medically tailored meals.

I wanted to take the opportunity to share more about MANNA’s innovative and strategic partnerships with insurance payers through Medicaid and Medicare Advantage (Medicare-approved policies offered by private companies as an alternative to traditional Medicare coverage for people 65 or older, as well as people with some disabilities and long-term conditions). Medicaid has been in the news a lot this year, so I also wanted to share some of the most salient changes to the program that have happened so far in 2023. MANNA continues to strategize and plan for how these changes might affect our services.

We’re getting closer to our goal of securing medically tailored meals as a standard, covered insurance benefit. However, most of our clients still receive our services outside of insurance mechanisms. Philanthropic funding for our program remains as important as ever.

Medicaid and MANNA

Pennsylvania’s Medicaid program covers children, pregnant women, parents, seniors, and people with disabilities, as well as other adults who are eligible for federally assisted income maintenance payments. In 2023, eligibility levels for parents of dependent children are presented as a percentage of the 2023 federal poverty level (FPL) for a family of three, which is $24,860. Eligibility limits for other adults are presented as a percentage of the 2023 FPL for an individual, which is $14,580.

In 2015, MANNA was one of the first nonprofit medically tailored meal providers in the country to seek out and secure Medicaid insurance reimbursement for our services. Since then, MANNA’s model has helped inspire similar programs across the country. Our research helped convince California lawmakers to test the efficacy of medically tailored meals in a statewide pilot program. Ultimately, California followed our model in their groundbreaking CalAIM program (which provides coverage for medically tailored meals in addition to other “community supports,” such as housing navigation, asthma remediation, personal care services, etc.).

MANNA currently partners with seven different insurance plans. MANNA’s Strategic Partnerships and Medical Billing teams work with these plans to ensure that MANNA’s services reach eligible members who would benefit. Through these partnerships, MANNA is also developing a robust additional revenue stream to power our philanthropic work. The length of coverage varies from plan to plan but includes at most 16 weeks’ worth of our home-delivered, medically tailored meals (typically coverage lasts for just one to three months. Medicare Advantage plans rarely cover more than four weeks of medically tailored meals). Medicaid coverage for medically tailored meals in Pennsylvania extends to many prevalent conditions (diabetes, chronic kidney disease and end-stage renal disease, congestive heart failure, etc.), as well as conditions such as high-risk pregnancy and malnutrition. Some plans allow MANNA the option to “recertify” or re-enroll their members for additional coverage, but others limit the number of times that members can receive a medically tailored meal benefit.

While the coverage they provide is limited, our insurance payer partnerships help us to serve more clients in need in several important ways:

  • In addition to extending our services to more low-income clients through Medicaid, the reimbursement revenue from these partnerships helps to offset some costs of serving our clients whose insurance does not cover medically tailored meals.
  • These partnerships diversify our income to enhance our long-term financial sustainability.
  • Our insurance payer partners often share what we call “real-world data,” positive health outcomes that these partners see among their members that provide additional evidence attesting to the impact of MANNA’s services and the power of food as medicine.
  • Critically, these partnerships help get us a seat at the table to advocate for broader and more extensive coverage of medically tailored meals as a universal standard of care.

Medicaid changes in 2023

Changes to Medicaid in 2023 will impact food-as-medicine programs across the country. In January, the Centers for Medicare and Medicaid Services (CMS) issued new guidance that expanded innovative funding mechanisms that could broaden access to medically tailored meals, but limited enrollment in food-as-medicine programs to a maximum of six months, and only once per year. While medically tailored meals have been demonstrated to have dramatic and life-sustaining impacts in as little as 30 days, for clients to reap all of the nutritional and educational benefits that MANNA’s program has to offer, coverage periods should be tailored to an individual’s needs, not one size fits all. Already, coverage is limited – we need more coverage, not less.

Another hurdle came this spring, when the pandemic-era pause on Medicaid recertifications ended and beneficiaries were required to reapply for coverage. It’s early in this process, but preliminary data from June indicate that 20% of Pennsylvanians have lost their coverage, just under half of whom were removed for procedural reasons such as failing to return paperwork. More than one million people have lost Medicaid coverage nationally. MANNA works with our clients to ensure they don’t lose their coverage, providing resources on accessing the benefits that are available to them, including Medicaid. (One of our partnerships with nonprofit Benefits Data Trust connects clients to BenePhilly, a hotline that helps Philadelphia residents access assistance programs that can help them afford food, heat, healthcare, and more.)

Work requirements for Medicaid made headlines this year when House Republicans pushed for them as part of a proposed debt ceiling bill. This was promptly struck down at the federal level. Some states are able to implement work requirements as a component of limited Medicaid expansion, but fortunately, Pennsylvania is not one of them. Pennsylvania has no work requirements for Medicaid, which is necessary for many low-income Pennsylvanians, including our critically ill clients. MANNA clients are just beginning chemotherapy treatments, recovering from recent hospitalizations, healing surgical wounds, or experiencing other serious and exhausting medical events. Many of our clients are unable to go to the grocery store and procure food for themselves, let alone satisfy weekly work requirements.

Moreover, many MANNA clients care for dependent children and adults in their household. Last year, MANNA delivered more than 97,000 nutritious meals to dependents in our clients’ homes. Currently, health insurance does not provide coverage for dependent meals. MANNA relies on the generosity of our philanthropic funders to provide this service.

The push continues

Part of my role is to collaborate with and support MANNA’s Strategic Partnerships team, to make the case to Medicaid insurance providers that expanding coverage of medically tailored meals is a cost-effective way to improve health outcomes among members who are often the sickest and struggling with multiple health conditions. A 2022 issue brief from The Commonwealth Fund found that the U.S. spends twice as much on healthcare than the average high-income country, yet has the highest rate of people with multiple chronic conditions, and the highest death rates for avoidable or treatable conditions. In 2013 MANNA published the first research in the country showing the association between receiving home-delivered medically tailored meals and a reduction in healthcare usage and costs: the average monthly health care costs were 31% lower in the MANNA client group versus the comparison group.

Today, a growing body of research supports the power of home-delivered medically tailored meals as an extremely efficacious and cost-effective intervention:

  • A 2019 study found medically tailored meals to be associated with 49% fewer hospitalizations and 72% fewer admissions into skilled nursing facilities compared to matched control groups.
  • A 2022 study found that a national medically tailored meal program could help avert 1.6 million hospitalizations and save $13.6 billion annually.

Expansive coverage for medically tailored meals will help improve health and well-being for more Pennsylvanians struggling with serious diseases. More coverage will also help us continue to learn more about the benefits of food as medicine through more extensive study and research. Robust Medicaid coverage ensures that our critically ill neighbors can receive the holistic care they need: through their hospital, their pharmacy, their other care providers, and their prescribed medical diets.

We’re grateful for your support as MANNA continues to advocate for medically tailored meals as a universal, covered benefit, accessible and available to all who need them. Until we achieve this goal, philanthropic funding is crucial to our ability to serve our critically ill clients. The push continues!