Feature Story
Addressing the Food Needs of Children and Families through Medicaid-Based Strategies
By MFSN Co-Designers
Published May 2 2024
Across a series of meetings between December 2023 and February 2024, the Medicaid Food Security Network (MFSN) Co-Designers and Steering Committee created the “Promising Medicaid-Based Strategies to Address the Food Needs of Children and Families” resource. This resource offers a menu of strategies for addressing the food needs of children and families through Medicaid.
This article introduces each of these strategic opportunities, why the MFSN has chosen to highlight them, and brings them to life through specific state-based examples. For the full “Promising Medicaid-Based Strategies to Address the Food Needs of Children and Families” resource, visit the MFSN website. Find more information on the examples highlighted in this article along with many more across other states in the newly-launched Medicaid Food Security Policy Dashboard.
Policy and Program Opportunities
The Managed Care Organization (MCO) Procurement Process
Medicaid agencies may include specific questions in their managed care Request for Proposal (RFP) to assess MCO readiness to effectively implement food-related strategies, including SNAP and WIC enrollment.
In Michigan’s 2023 Medicaid Managed Care Request for Procurement, bidders were required to address questions regarding the managed care organization’s approach to addressing enrollees’ health related social needs (HRSNs) and promoting health equity such as using a data-informed approach to proactively identify enrollees who may have HRSNs and would benefit from social services and describing their proposed approach to working with and supporting CBOs through sustainable financing arrangements to provide social services, such as through partnerships related to community reinvestment.
Food Insecurity Screening and Referral
Food insecurity screening and referral is an essential first step for identifying food insecurity and connecting Medicaid enrollees to food resources.
In Massachusetts, primary care-based social needs screening is promoted and supported through value-based payment subcapitation models. Higher tier practices, which are practices meeting quality criteria to receive increased funds, must meet staffing requirements for roles designed to provide these types of support.
Assistance and Navigation
Medicaid programs could use their pre-existing or new care coordination and community navigation workforce to support connection to food benefits and resources for children and families. This workforce may include Community Health Workers, Promotoras, Community Health Representatives and Patient Navigators who have deep community connections and expertise.
In South Dakota, community navigator agencies are permitted to enroll clients in Medicaid and be reimbursed for services, including navigation and resource coordination for community resources and programs addressing Social Drivers of Health (SDoH). In addition, these agencies may bill some SDoH diagnosis codes as primary or secondary diagnosis codes.
Data, Evaluation and Continuous Improvement
Addressing food security in healthcare requires new data infrastructure to support care coordination and quality improvement strategies to ensure that these programs have the intended impact on health and health equity.
As part of Washington, D.C.’s Quality Improvement strategy, MCOs must identify disparities in health services and health outcomes between subpopulations or groups, identify social determinants of health, and identify the cause of disparities. MCOs must then develop a plan of action and a timeline to remediate the social determinants of health and health disparities and include this plan and timeline in the required reporting to the state.
Investments and Benefits
States can invest in food benefits/resources to supplement and complement SNAP and WIC to meet the health needs of children and families and to further strengthen the local food systems. Avenues include strategies such as 1115 waivers and In Lieu of Services, requiring MCOs to reinvest a portion of their profits, encouraging value added services.
In January 2024, the Centers for Medicare and Medicaid Services (CMS) approved the “New York Health Equity Reform (NYHER)” amendment and extension to New York’s “Medicaid Redesign Team” 1115 demonstration waiver. Through the waiver, HRSN services will be provided to those who “medically need” the service and who are children under the age of six (no chronic condition required), children under the age of 18 with one or more chronic conditions, and pregnant individuals up to 12 months postpartum, among others. Allowable nutrition services include nutrition counseling, home delivered meals (up to 3 meals per day), medically tailored or nutritionally appropriate food prescriptions, fresh produce, and nonperishable groceries. Allowable supports also include cooking supplies necessary for meal preparation such as pots, pans, utensils, microwaves, and refrigerators.
Integrated SNAP, WIC and Medicaid Infrastructure
While many of the strategies above would actively assist individual Medicaid Enrollees in navigating complex systems, state governments can simultaneously work to streamline their benefit systems so that any Medicaid enrollee attempting to access these benefits would have a smooth client experience in applying for and utilizing them – especially in light of the overlapping eligibility requirements between Medicaid and SNAP, and the automatic conferred eligibility from Medicaid to WIC.
In New Hampshire, the SNAP, WIC, and Medicaid programs have a Memorandum of Agreement for data sharing and expedited enrollment. Families receiving SNAP and/or Medicaid are automatically eligible for the WIC program. The WIC agency receives contact information for WIC-eligible households on SNAP and Medicaid; this information is available on a dashboard for local WIC staff and if the household is not already enrolled, WIC staff will initiate an enrollment appointment.
Tools and Resources to Learn More
Visit the MFSN website for resources to support implementation of these promising strategies, including the recently launched Medicaid Food Security Policy Dashboard and Medicaid and Food Security 101 learning series. You can also find the full “Promising Medicaid-Based Strategies to Address the Food Needs of Children and Families” resource on the MFSN website, which provides a deeper dive into each of the strategies outlined in this article.