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Feb 2025 updates from the Medicaid Food Security Network

We hope everyone is staying warm and building solidarity in these times of freezing. Speaking of coalition-building – MFSN is celebrating its 1st birthday! What better way to celebrate than to party, by which we mean, hold a deeply technical national summit May 7-8 in Washington, DC. The theme is Policy strategies for Medicaid and MCOs to improve SNAP, WIC, & Food is Medicine coordination. There is no registration fee, but there is limited space. Please register here by April 4. If you’re already going to the FRAC conference on May 4-6, this could be a great extension of your DC trip, as we’re in the same hotel, the Omni Shoreham.

Protecting programs like SNAP and Medicaid is more important than ever. In our Feature Story, we recap what we’re hearing from Washington and what we see as the path forward to continuing expanding Medicaid food strategies. We encourage folks to:

Tell Congress to protect SNAP from funding cuts
Tell Congress to protect Medicaid too! (thanks to friends at Families USA for this call to action)

We’re also celebrating the recent addition of Katrina Scott (she/her) to the Share Our Strength/MFSN team as Health Systems Associate. Katrina recently served as Share Our Strength’s Healthy Families Produce Rx program coordinator. She plays a key role in MFSN’s day-to-day operations and management, including leading the MFSN News Digest you’re reading right now. Previously, Katrina worked as a field researcher for the University of Michigan Institute of Social Research. She has a master’s degree in cultural anthropology from the City University of New York Graduate Center. Katrina started her career in broadcast journalism working as a television news writer and producer at MSNBC, WNYC Radio, WWOR-TV, and WVUE-TV.

We also welcome Cate Hensley, Manager of Policy and Projects at the Food is Medicine Coalition, and Gina Plata-Nino, SNAP Deputy Director at FRAC, who is taking the place of Alex Ashbrook. Jean Terranova from Community Servings has transitioned off the committee, and we thank both Alex and Jean for their immense contributions to MFSN in its first year!

A few other things we’ve been up to:

Our request for grant applications to participate in the MFSN Partners Program just closed – we thank y’all for the numerous quality applications and the work you do in your communities. We’ll make funding notifications in mid-March.
Julian and Kathryn presented a poster at the SIREN National Research Meeting on Feb 4 that discusses our MFSN Policy Dashboard.
MFSN submitted a response to the Administration for Children and Families Request for Information on developing interoperability standards for human service programs. In our comment, we discuss the value of sharing SNAP and WIC data to healthcare, including managed care organizations (MCOs) and hospital systems, to improve outreach and evaluation – and how we could overcome some of the barriers to data sharing.

Upcoming Events & Opportunities

March 11: Join our webinar Addressing Food Insecurity Through Medicaid: Four Innovative State-Based Approaches hosted by The Root Cause Coalition. Register here.

March 12: Find us at the 2nd Annual Food is Medicine (FIM) Advocacy Day on Capitol Hill with the Food is Medicine Coalition. Visit and educate key members of Congress and their staff on how FIM can address food and nutrition insecurity. To register for the day, email emily.callahan@tufts.edu and kirsten.deuman@tufts.edu.

May 4-6: Find us at the National Anti-Hunger Policy Conference in Washington, DC sponsored by the Food Research & Action Center (FRAC).

Feature Story

In this post, we summarize what we’ve been tracking in the federal Medicaid and food security landscape, discuss some brief history of the first Trump Administration’s approach to HRSN (health-related social needs, often used interchangeably with social drivers of health (SDOH)), and look forward at how we as a community may continue advancing food and nutrition security for children and families through Medicaid policy. Despite much dialogue surrounding Medicaid and SNAP since the inauguration, it’s still too early to know what’s truly ahead, and we’ll continue to monitor developments and provide updates plus calls to action to the Medicaid Food Security Network.

Medicaid, SNAP, and WIC are critical federal programs that improve health, and food and nutrition security. Cuts to any one of these programs threaten the other because these programs are mutually reinforcing and interconnected both at the participant level and at the agency level when it comes to data-sharing and organizational efficiencies. As part of the Budget Reconciliation process, the House Budget Committee has passed a budget resolution that would likely cause major Medicaid and SNAP cuts.
Two calls to action: contact your member of Congress to protect SNAP to support the food and nutrition security of children and their families, and contact members of Congress to protect Medicaid.
MFSN will continue to support Medicaid strategies for food security. These strategies remain on the table, though the field may shift away from 1115 waivers and towards other Medicaid policy tools and existing flexibilities.
The previous Trump administration supported efforts to address HRSN in Medicaid, and RFK Jr. is supportive of Food is Medicine. We don’t yet know how HHS’s ambitious agenda interacts with the cuts proposed across health and nutrition benefits. Either way, FIM is a potential common ground through which we can advance our shared mission of mobilizing the Medicaid system to support food and nutrition security.

Highlights & New Resources

Federal and State Policy Updates

Biden Administration CMS Approves 1115 Waivers Addressing Health-Related Social Needs (HRSN)

Between December 2024 and January 2025, the Centers for Medicare and Medicaid Services (CMS) approved Medicaid 1115 waiver HRSN projects in multiple states. Here, we summarize the programs that will likely address food security for children and families.

Hawaii – On January 8, CMS approved the state’s 1115 demonstration, “Hawaii QUEST Integration” (effective through December 2029) to add HRSN interventions for members with a medical need who are also food insecure, including nutrition instruction, home-delivered meals or pantry stocking, medically tailored meals, nutrition prescriptions, and cooking supplies when not available through other programs. In terms of categories with broad reach, these services are available to pregnant and postpartum individuals, and anyone with diet-related illnesses including prediabetes, hypertension, diabetes, or obesity. The waiver also supports HRSN infrastructure improvements to support identifying and referring eligible members for nutrition interventions.

Massachusetts – On January 15, 2025, CMS approved Massachusetts Special Terms and Conditions for its MassHealth Medicaid and Children’s Health Insurance Program (CHIP) 1115 demonstration, which is effective through December 2027. This is a conversion of the state’s Flexible Service Program, which enabled Accountable Care Organizations (ACOs) to fund community partners to provide housing and nutrition supports. Among the allowable HRSN services are referral and application assistance for state and federal benefit programs such as SNAP and WIC (Massachusetts 2024 state fee schedule documentation suggests the state had not opted to pay for this as a standalone service, though MassHealth describes how members can be assisted with SNAP and WIC access, including through referrals to USDA-funded SNAP outreach organizations), and standalone nutrition counseling and education, up to three meals per day of home delivered meals for up to six months, nutrition prescriptions for up to six months, and cooking supplies. According to the state Implementation Plan, the Medicaid and SNAP agencies are discussing data-sharing protocols to provide ACO-specific “SNAP Gap reports” to support outreach for ACO members not enrolled in SNAP. The waiver also supports the state’s Hospital Quality and Equity Initiative and performance improvement efforts related to demographic and HRSN data collection.

North Carolina – On December 10, 2024, CMS approved North Carolina’s Medicaid Reform Demonstration 1115 waiver (effective through December 9, 2029). This is a renewal of the state’s Healthy Opportunities Pilots and continues coverage of HRSN services for eligible members with a health and social risk factor, including addressing food insecurity. Nutrition interventions include case management services, like outreach, education, and connection to SNAP and WIC; nutrition counseling and instruction; home-delivered and medically tailored meals, and nutrition prescriptions.

Pennsylvania – On December 26, CMS approved Pennsylvania’s five-year Keystones of Health 1115 demonstration to provide housing, re-entry, and nutrition support services, including food boxes or home-delivered meals for children or pregnant members, and medically-tailored meals for members with a nutrition-sensitive medical condition. The waiver also allows HRSN infrastructure investments. Unlike Pennsylvania’s original application, SNAP and WIC application assistance do not appear as services the waiver would pay for. However, there is nonetheless language describing how the 1115 waiver will contribute to SNAP and WIC enrollment coordination and reporting – something we know PA already pays attention to given that the state shares SNAP enrollment data to its MCOs to enable targeted outreach as we covered in a previous MFSN digest.

Washington state received CMS approval to expand their 1115 waiver to include nutrition supports in the form of nutrition counseling, medically tailored meals, pantry stocking, produce prescriptions, and short-term grocery provisions for any Medicaid member with a social risk factor and clinical risk factor. In addition, the waiver allows “Case Management, Outreach, and Education” for all Medicaid members to connect members to WIC, SNAP, and other public benefits.
In addition, in November 2024, multiple states – CO, HI, MN, PA, NY, and WA – had 1115 waiver provisions approved that extend continuous coverage for children under Medicaid.
Lastly, we’re paying attention to Colorado’s proposed 1115 waiver expansion submitted in December 2024 that would pay for nutrition and housing support. In the leadup, MFSN supported Colorado advocates who were successful in getting the state to pass legislation that led to a feasibility study, which is the critical first step towards an 1115 waiver.

Covered California Starts Population Health Quality Improvement Program

Covered California’s Quality Transformation Initiative (QTI) plans to reinvest $15 million in penalties collected from insurers failing to meet quality benchmarks into programs addressing HRSNs. The Population Health Investments (PopHI) initiative will fund grocery support, vaccine incentives, and primary care improvements. Members with chronic conditions experiencing food insecurity will receive up to $960 annually for groceries, while families with children under two can earn up to $1,000 for completing vaccinations, with funds deposited into college savings accounts.

CMS Cuts ACA Navigator Funding to $10 Million

CMS plans to reduce funding for the Affordable Care Act (ACA) Navigator program to $10 million annually, a 90% cut from its 2024 budget of $98 million. This would likely lead to fewer people securing critical healthcare coverage, given the level of hands-on assistance that ACA Navigators provide to help people apply for health insurance through the ACA Marketplace and Medicaid. Navigators assist people with gathering application documents (like income verification) and assist with problems relating to claims and billing. Navigator services remain important given the complexity of applying to public benefits.

Medicaid Work-Reporting Requirements

Multiple states have taken steps to implement Medicaid work-reporting requirements since the start of the Trump administration, as this would likely require federal approval through Medicaid 1115 waivers. Of the six mentioned below, Ohio and South Carolina submitted their requests to CMS last month; Arkansas plans to submit its 1115 waiver after the public comments period ends next month; and Idaho, Indiana, and Montana have advanced bills in their state legislatures.

Idaho House Committee Advances Medicaid Expansion ‘Reform-or-Repeal’ Bill with Work Requirements

The Idaho House Health and Welfare Committee’s bill requires Idaho to implement 11 policy changes in Medicaid or repeal Medicaid expansion by July 2026. Besides work requirements, those changes include a cap on Medicaid expansion enrollment and a ban on Medicaid expansion eligibility after three years of benefits.

Indiana Senate Approves HIP Enrollment Cap, Medicaid Work Requirement Bill

The Indiana Senate’s bill also caps enrollment in the state’s Medicaid program, the Healthy Indiana Plan (HIP) to 500,000. Current enrollment is over 750,000.

Montana Senate Committee Advances Medicaid Expansion Renewal Bill with Work Requirements

The Montana Senate Finance and Claims Committee approved a House bill to renew Medicaid expansion and remove the Medicaid expansion sunset provision. The expansion also includes work requirements.

Arkansas, Ohio, and South Carolina seek to reinstate work requirements previously approved in 2018

Ohio and South Carolina have announced plans to implement the same work requirements approved under the first Trump administration. Meanwhile, Arkansas’s second waiver request differs in a few ways from the 2018 version that was halted by a federal judge. The state claims that it will use data-matching using SNAP and TANF to confirm work status where possible to reduce participant reporting burden. Arkansas would also suspend instead of disenrolling people who are out of compliance with the work reporting requirements.

Congressional Bills on FIM

H.R.5568 – CARE for Moms Act

This bill aimed to enhance maternal health by promoting access to prenatal and postpartum care and providing resources for mothers and babies. Of note, this bill proposed to extend for postpartum individuals Medicaid coverage from 60 days to 1 year, and WIC coverage from 1 year to 2 years. It would establish grant programs to address bias, promote cultural competence, and equip Rural Obstetric Mobile Units. It would also support growing and diversifying the doula workforce and require notification for hospital obstetric unit closures. The bill was referred to the Energy and Commerce Subcommittee on Health in December 2024 but it remains to be seen whether it will be reintroduced in the next Congress.

H.R.10124 – Fueling Optimal Outcomes through Diet (FOOD) for Health Act

This bill proposed a pilot grant program supporting Food is Medicine programs. Grant funds can be used for on-site emergency feeding, cooking skills programs, medically tailored food delivery, and transportation. The USDA and HHS would be instructed to prioritize health equity when awarding grants and issue a report on program outcomes. The bill was referred to the Agriculture Subcommittee on Nutrition, Foreign Agriculture, and Horticulture in December 2024, and also remains to be seen whether it will be reintroduced.

Resources

Medicaid Food Security Policy Dashboard

We wanted to remind folks about the MFSN Policy Dashboard, which is the result of our review of state Medicaid Managed Care Contracts, 1115 waivers, and other policy documents to develop a compendium of examples of how Medicaid addresses food insecurity among children and families. This tool is not an exhaustive list of programs and policies that address food insecurity through Medicaid, and we’re updating it with 2024-2025 information as we speak.

Medicaid Nutrition Supports: Implementation Innovations

This webinar, part of the Medicaid Health-Related Social Needs Implementation Learning Series, explored how states can better tailor nutrition service design and implementation to maximize positive impacts on enrollee health. It featured a panel discussion with Medicaid agency staff from Massachusetts and Michigan, who are pursuing nutrition supports under different Medicaid authorities.

Meeting Health-Related Social Needs through Medicaid: Resource Center

Medicaid agencies across the US are pursuing opportunities to address members’ HRSN to enhance health and well-being, reduce disparities, and lower health care costs. This new resource center, developed by the Center for Health Care Strategies (CHCS), highlights promising HRSN program design and implementation considerations for state Medicaid agencies and their partners. Resources are organized in the following key areas: Designing Medicaid Benefits, Supporting Health Care and Community-Based Organization Partnerships, and Developing Accountability Mechanisms.

Purged Federal Agency Data Available on PolicyMap

Data recently removed by the Trump administration is available on PolicyMap. Data from CDC PLACES (Population Level Analysis and Community Estimates), the Social Vulnerability Index (SVI), and the Climate and Economic Justice Screening Tool (CEJST) are some of the data accessible on its platform.

News Digest: February 2025

Feb 2025 updates from the Medicaid Food Security Network

Upcoming Events & Opportunities

Feature Story

Highlights & New Resources

Federal and State Policy Updates

Medicaid Work-Reporting Requirements

Congressional Bills on FIM

Resources

Recommended Reading

February 2025

January 2025

2024