Updates from the Medicaid Food Security Network

Summer invites us to linger a little longer—to make the most of extended daylight, tend what we’ve planted, and gather the season’s abundance. In that same spirit, this edition of the Medicaid Food Security Network Digest offers a midsummer harvest of news, policy updates, and practical resources. From welcoming a new cohort of state partners and sharing a new policy brief to tracking major changes affecting Medicaid and SNAP, we hope these updates provide timely information and useful tools to support your work in advancing nutrition security and health. While we cannot hold onto the longer days, we can, and must, continue to shape the opportunities and policies that increase access to food and nutrition security. With this in mind, we encourage you to delve into our Embedding Strategies to Address Food Insecurity in Medicaid Managed Care Contracts and to also raise your individual and collective voices in opposition to the DHS’s new “public charge” rule, which will harm food access for our immigrant neighbors. Policies that harm their wellbeing have a deleterious impact on entire communities.

 

 

MFSN Announcements

• New Cohort. We’re excited to announce four new grantees for the Medicaid Food Security Partners Program (MFSPP): New Growth (MO), North Carolina Food is Medicine Coalition, Public Health Management Corporation (PA) and West Virginia Food and Farm Coalition, each receiving $100,000 over the 18-month grant period that started in June. ICYMI! We’ve also released a micro-report on the potential impact of the work of our first grantee cohort.
• Fall Quarterly Convening. Register for the next MFSN virtual event on Thursday, September 17, where we’ll take a closer look at the MCO model contract language presented in Embedding Strategies to Address Food Insecurity in Medicaid Managed Care Contracts and more. Look out for more details and additional presenters in the coming weeks.
• Spring Summit. We’re also working on the next MFSN National Summit. The second summit will take place March 17-18,2027 in Dallas, TX. Look out for more details this fall. Go here to learn about the 2025 summit and read the full report with key insights and takeaways.
• Resources Survey Results. Thank you to those who completed our survey. We appreciate your feedback and were glad to hear of your overall satisfaction with our “valuable” and “relevant” digests. A few of you found at least one of the briefs – FIM is Complementary and Calculating the Costs – along with the Policy Dashboard, “helpful” and a “great reference” for your work. That is our goal, and we hope that you will find our new brief just as useful. We also understand that our newsletters offer a lot of information. We will work to streamline our focus in the future while also providing you with more resources on FIM services, Medicaid funding for food security, and the MCO contract procurement process.

New Policy Brief

Embedding Strategies to Address Food Insecurity in Medicaid Managed Care Contracts

Children and families enrolled in Medicaid face a high risk of food and nutrition insecurity. One approach to mobilizing Medicaid Managed Care Organizations (MCOs) to address health-related social needs (HRSN) is through Medicaid procurement contracts. This MFSN brief by Kathryn Jantz of Hearthwise Consulting and Julian Xie, former Medicaid and Food Insecurity Director at Share Our Strength, builds on two MFSN resources – Food is Medicine is Complementary with SNAP & WIC and Promising Medicaid-Based Strategies – by recommending food and nutrition strategies for Medicaid agencies to integrate into MCO contracts and mapping out specific components of contract language across key areas that could move MCOs to address food and nutrition insecurity, often without additional state spending.

 

Informed by a review of Medicaid contracts and other documents found on the Medicaid Food Security Policy Dashboard, this practical policy tool mirrors standard MCO contract categories:

• Food Insecurity Screening and Referral
• Assistance and Navigation
• Quality Improvement, Population Health, And Social Drivers Of Health Plans
• Investments and Benefits

It also provides a checklist of contract language elements designed to maximize contractual requirements.

Upcoming Events and Opportunities

September 18: Request for Application deadline for Healthy Food Financing Initiative. The USDA program has $20M available for capacity-building and credit-enhancement grants for regional, state, or local public/private partnerships of two or more entities organized to improve access to fresh, healthy foods and to provide financial and technical assistance to eligible projects in underserved areas.

 

September – November 2026: Pre-register for the new course “Blended Value for Food is Medicine” and receive 10% off once registration opens. HealthBegins and DAISA Enterprises developed this cohort-based course to show FIM organizations how to use blended value calculations to effectively communicate program impact to health systems and MCOs. To learn more, read “Mapping Blended Value in Food is Medicine”.

 

September 30: The American Public Human Services Association (APHSA) and No Kid Hungry have released a Request for Proposals (RFP) for a third cohort of Coordinating SNAP and Nutrition Supports (CSNS) sites in 2027. The selected sites will address emerging SNAP operational and policy challenges by strengthening program access, improving efficiency, and supporting families navigating nutrition assistance.

 

October 28: Register for the Day 1 free livestream of the 4th Annual FIM National Summit, hosted by Food is Medicine Institute at Tufts University. In-person attendance for the two-day event in Boston is by invitation only.

 

December 1: Save the date for the 4th Annual Texas NMDOH Consortium Conference in Houston. This one-day event explores state and federal policy developments impacting the financing and implementation of non-medical determinants of health services within healthcare.

 

December 10: Register to join nearly 200 policymakers, practitioners, and advocates in Columbia, SC for the Food is Medicine South Carolina (FiMSC) Annual Meeting. This one-day event will spotlight local FIM programs and explore ways to expand FIM statewide.

 

To stay connected to the Network and news on upcoming events, join the MFSN LinkedIn group.

What We’re Watching: Policy & Programs

Medicaid Work Requirements

Five more months remain for all 50 states and the District of Columbia to implement the Centers for Medicare & Medicaid Services’ (CMS) Interim Final Rule establishing an 80-hour monthly work requirement for certain Medicaid applicants and enrollees ages 19 through 64.

Here’s what we know:

• Arkansas, Montana and Nebraska have started early rollouts or soft launches.
• Work requirements can be fulfilled through employment, education, work programs, or community service, and must be implemented by states no later than January 1, 2027.
• The rule exempts individuals who are pregnant, postpartum, disabled, medically frail, American Indian or Alaska Native, caregivers, or already complying with SNAP or TANF.
• CMS’s limits on the medical frailty exemptions prompted half of the states and the District of Columbia to file a lawsuit arguing that the Trump administration has created limits that go beyond the statute and will prevent eligible Americans from accessing necessary healthcare.
• The interim final rule went into effect on July 31. FamiliesUSA provides a useful breakdown comparing the H.R. 1 statute, CMS guidance and IFR.

 

SNAP Benefits

Recent Trump administration decisions will severely impact many families receiving SNAP benefits, leaving lawfully present immigrant families and officials in dozens of states to confront some difficult choices.

 

New Public Charge Rule & SNAP

In a significant policy shift, immigration officers can now factor in whether green card applicants received SNAP benefits when approving green cards. The new final rule issued by the U.S. Department of Homeland Security (DHS) rescinded the 2022 public charge rule that allowed agents to consider only whether applicants received cash assistance such as Temporary Assistance for Needy Families (TANF). The new rule allows for a broader interpretation by immigration agents and the inclusion of whether applicants received SNAP or Medicaid. This policy, scheduled to go into effect on September 18, could impact 950K people. It also will increase confusion and the risk that a family’s participation in vital programs could count against lawfully present green card applicants.

 

Share Our Strength, an MFSN co-designer, and Children’s HealthWatch, an MFSN steering committee member, have each released statements opposing the final rule.

 

Payment Error Rates Released

SNAP payment error rates released for FY25 will determine whether states are, for the first time, liable for SNAP benefits and administrative costs under H.R. 1.

 

This USDA data highlights how states will be affected:

• 7 states above 13.3% qualify for an FY28 exemption: AK, DE, DC, GA, IL, NM, OR.
• 10 states below 6% face no cost share in FY28: ID, IA, KY, NE, SD, UT, VT, VI, WI, WY.
• As many as 36 states and territories face a 5–15% cost share.

Payment error rates measure administrative overpayments or underpayments due to program complexity, not fraud. For a closer look at how these error rates are calculated, check out this explainer.

 

The cost-share requirement begins October 1, 2027, though low-error states are exempt and the highest-error states will receive a delay.

Policy Highlights & Resources

State Policy Updates

Hawaii Seeks Input on HRSN-Focused Procurements

The Hawaii County Office of Aging has released two requests for information (RFIs) to inform upcoming procurements addressing health-related social needs (HRSN). One of the RFIs is for nutrition services for older residents, which includes congregate and home-delivered meals, nutrition transportation, and nutrition education.

Illinois Finalizes $431B Medicaid Managed Care Awards

The Illinois Department of Healthcare and Family Services awarded a $431.4 billion, 10-year HealthChoice contract to CVS/Aetna, HCSC/Blue Cross Blue Shield, Centene/Meridian, Molina, and Humana. Starting January 1, 2027, the agreement focuses on care coordination, behavioral health, and social determinants of health.

Michigan Allocates $168M to Implement Federal Medicaid and SNAP Changes

The Michigan Department of Health and Human Services (MDHHS) announced that, out of its nearly $31B FY27 budget, roughly $168.6M will be allocated to implement new federal H.R. 1 requirements. This includes $94.3M for increased state shares of SNAP administrative costs, $54.3M for required changes to Medicaid and SNAP, and $20M in supplemental FY26 grants for community-based groups assisting with program eligibility.

Missouri Issues Medicaid Managed Care RFP for Statewide Health Plan Contracts

The MO HealthNet Division released an RFP on July 1, 2026, for statewide Medicaid managed care services, planning to award up to three General Plans and one Specialty Plan. Proposals are due September 2, with operations starting in 2027 for a one-year term and four optional renewals.

New York To Submit Section 1115 Medicaid Redesign Team (MRT) Demonstration Extension

The New York State Department of Health seeks a five-year extension of its 1115 Medicaid Redesign Team (MRT) demonstration before its March 2027 expiration. The state also plans to update Health-Related Social Needs (HRSN) services by maintaining Social Care Networks and delaying risk-based funding until April 2028. Public comments are open through August 21.

North Carolina provides funding for Healthy Opportunities Pilots (HOP)

NC Governor Josh Stein’s $34.4 billion budget provides $9.3 billion for DHHS, which includes $25 million in nonrecurring funds to restart the Healthy Opportunities Pilot (HOP), though this falls short of the requested level. Read about HOP’s successes and savings in the Healthy Opportunities Pilots Summative Evaluation Report.

Rhode Island to seek 1115 waiver and develop FIM pilot program

Legislation signed by Governor Dan McKee directs the Rhode Island Executive Office of Health and Human Services (EOHHS) to create a task force to develop a Food As Medicine pilot program and authorizes EOHHS to seek an 1115 waiver to cover nutrition supports.

Texas upgrades WIC benefits card with real-time tracking through new app

The Texas Health and Human Services Commission launched upgraded electronic benefits cards for the WIC nutrition program on July 1. Integrated with the updated myWIC mobile app, the new system allows real-time tracking of benefits and purchases, remote updates without requiring in-person visits, and the ability to freeze or unfreeze benefits for enhanced security.

Federal Policy Updates

CMS releases new Medicaid and CHIP enrollment numbers

The latest Medicaid and CHIP Eligibility Operations and Enrollment Snapshot shows that hundreds of thousands of children and adults once considered eligible for Medicaid and CHIP are no longer enrolled. The Centers for Medicare and Medicaid Services (CMS) reports that 73.8 million children and adults were enrolled in both programs in April 2026, down more than 1.5 million from January 2026. Over the four months, 1.3 million people stopped participating in Medicaid, with CMS reporting 66.7 million Medicaid participants in April.

CMS ends “Fast Track” process for 1115 applications as it plans to reshape 1115 budget neutrality reviews

A newly released informational bulletin from CMS rescinds the “fast track” process established in 2015 for reviewing state proposals to extend longstanding Section 1115 demonstrations. This bulletin follows guidance issued on June 11 in a State Medicaid Directors’ Letter regarding upcoming budget neutrality requirements for Section 1115 Medicaid demonstrations, which take effect January 1, 2027, under H.R. 1, the FY 2025 budget reconciliation law. The law requires the CMS Chief Actuary to certify that federal spending for new waivers, amendments, or renewals does not exceed the amount that would have been spent without the demonstration.

 

CMS plans to issue a proposed rule before the effective date but will apply this guidance provisionally if the rule is not finalized in time. Consequently, states must now provide explicit operational details, including eligibility criteria and payment methodologies, during the financial analysis phase of their applications.

 

For a detailed breakdown of the changes and impact on states with 1115 waivers, check out the following resources:

• New Budget Neutrality Guidance for Medicaid Section 1115 Demonstrations from State Health & Value Strategies (SHVS), a program of the Robert Wood Johnson Foundation based at Princeton University’s School of Public and International Affairs
• 1115 Waiver Guidance Introduces New Hurdles to State Medicaid Innovation from the Center for Health Law and Policy Innovation (CHLPI)

Resources

Food Insecurity

From Progress to Peril: Food Security Screening, Social Care Integration, and a Path Forward

This brief from Children’s HealthWatch and FRAC examines the scope and consequences of federal policy changes and proposes an agenda for restoring and strengthening the integration of social care into healthcare

 

State Policy Pathways for Advancing Food and Nutrition Strategies to Improve Health

The Center for Health Care Strategies brief presents a framework for cross-sector action on food and nutrition insecurity. It details policy levers, state authorities, and best practices for integrating these strategies into Medicaid and other state systems.

 

Dashboard: Democratizing Our Data: Putting Evidence in Action

Check out the latest data snapshot, Food Insecurity in the U.S. from Children’s HealthWatch. This dashboard offers nine interconnected data domains, including food security, that are fully filterable and exportable

Food is Medicine (FIM)

Activating the Food Is Medicine Ecosystem: A Framework for Stakeholder Partnerships

Taking on a key strategic challenge in Food Is Medicine (FIM): establishing a systems-level understanding of the design, governance, and sustainability of intersectoral partnerships, the Milken Institute’s Feeding Change engaged nonprofits, health plans, funders, and FIM participants to develop a framework offering 50+ practical recommendations for collaboration.

 

Creating a FIM Continuum of Care

Based on a California pilot, this brief provides a practical framework for managed care plans to transition members from higher- to lower-intensity nutrition interventions as their needs evolve, improving long-term health outcomes and program sustainability.

 

Feeding America’s partnership with Elevance shows the power of FIM

This Feeding America evaluation shows how Food as Medicine programs improve health outcomes and reduce healthcare utilization. Using data from over 161,000 households across 13 states, it demonstrates the impact of pairing nutritious food with nutrition education and healthcare partnerships.

 

Toolkit: New Online Toolkit Helps Clinicians Put Food is Medicine into Practice

This resource offers practical guidance for all aspects of integrating nutrition-based care into health systems.

Benefits Coordination

How Community Health Workers Support Food Access

A new national survey from Share Our Strength’s No Kid Hungry and the National Association of Community Health Workers (NACHW) shows how essential Community Health Workers (CHWs) are to connecting families with food. The survey captured experiences from 231 CHWs and 50 employers across 45 states. 

 

Playbook: Nutrition in Housing

Share Our Strength and Mercy Housing created a playbook to help Resident Services Coordinators assist eligible residents in accessing SNAP benefits. Based on feedback from RSCs and housing staff, the guide offers practical tools and strategies to reduce barriers and establish trusted pathways to food resources within communities.

SNAP & WIC

Connecting Families to WIC: A Practical Toolkit for Health Care Providers

This practical toolkit helps healthcare providers integrate WIC referrals into clinical care to connect more eligible families with nutrition support. It offers actionable strategies, case studies, and best practices for screening, referral, and partnership to improve WIC participation and maternal and child health outcomes.

 

The Impact of HR1 SNAP Cuts on Children: Research Brief

Based on a January 2026 analysis of 2022–2023 USDA data, this research brief evaluates the effects of H.R. 1 provisions on children. It details the impacts of tightening eligibility for lawfully present noncitizens, expanding time limits for parents of teenagers, and shifting administrative and benefit costs to states, offering state-level estimates of affected populations.

 

Dashboard: SNAP Participation, January 2025 to present

SNAP Participation Tracker shows national and state enrollment changes since January 2025.

 

Toolkit: Farmers Market Nutrition Program (FMNP) Implementation

This toolkit features tip sheets and sample policies, agreements, applications and checklists.

 

Video: Everybody Needs Help

Nebraska parents share how they are feeding their children now that they no longer qualify for SNAP, in this NoKidHungry video.

Recommended Reading

Call to Action: Antihunger and Public Health Communities Must Find Common Ground to Advance a More Just and Nutritious Food System in the United States (American Journal of Public Health)

Food is Medicine (FIM)

Feasibility study of a screening decision tool for allocating adults into food is medicine (Frontiers)

FIM Coalition Announces Development of First Standard for MTGs (Food is Medicine Coalition)

Food is Medicine isn’t Either-Or; It’s both (HealthBegins)

Fresh Connect breaks out four different grocery cards (Supermarket News)

How Ownership-Based FIM Initiatives Can Advance Structural Change (Health Affairs)

Enforcers Weigh In on FIM Compliance with Health Care Laws and Abuse Fraud (Health Law Lab)

FIM: Medically Tailored Meals (MTM)

America’s public health programs must cover medically tailored meals (The Hill)

Medically Tailored Meals Produce Better Health and Lower Costs (Tufts)

Health-Related Social Needs (HRSN)

As GOP Cries Fraud, Newsom Backs Medicaid Spending on Housing and Food (KFF Health)

To Evaluate Interventions that Address Drivers of Health, Look Beyond ROI (Health Affairs)

SNAP/WIC

CT Governor Ned Lamont orders gift cards for residents losing SNAP (CT Mirror)

Direct Digital Referrals from Prenatal Care and WIC Enrollment (JAMA Network)

How a Year of SNAP Cuts is Pressuring the Food System (Civil Eats)

Post-Megabill Dropoff in SNAP Participation is Steepest in Decades (CBPP)

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