Opinion | Medicaid can help people eat healthier. Here’s how. – The Washington Post

Rachel Nuzum is senior vice president for policy at the Commonwealth Fund.

Almost 400,000 Americans on Medicaid have diabetes and are insulin-dependent. Forty percent of them have trouble affording healthy food. This means that despite the $34 billion Medicaid spends on these enrollees each year, almost half are likely to have trouble managing their conditions effectively.

This makes no sense. We know that the best — and most cost-effective — way to address diabetes is with a healthy diet, yet one of the largest sources of coverage in the United States — the Medicaid program — has had limited authority to tackle this fundamental need. The same is true of many other lifestyle-dependent health conditions.

Here’s a solution: Let Americans use Medicaid funds on nutrition and healthy food.

It’s not as radical as it might sound. Medicaid, which has been providing health coverage to the most vulnerable Americans since 1965, is perfectly suited for this role. In fact, both Democrats and Republicans are getting behind this approach.

The federal government has been approving state Medicaid demonstration projects addressing access to healthy food. Three states — Arkansas, Massachusetts and Oregon — have received the go-ahead to spend portions of their Medicaid budgets on things such as groceries and nutrition counseling.

Some might object that Medicaid is a health-care program. Why should its funding be used for food, especially when there are other programs dedicated to address hunger?

The answer is that Medicaid was designed to give states flexibility to test new ways to serve beneficiaries but with critical guardrails. By applying for waivers, states can experiment with policies to improve the health of their populations with some key provisions: They must promote the objective of the Medicaid program, and they must not increase federal spending and are subject to formal evaluation.

It’s clear that using Medicaid to pay for food falls within the mission of the program. In the summer of 2020, at the height of the covid-19 restrictions, some 45 million Americans — disproportionately Black and Latino Americans — did not always have enough to eat. And robust research shows that access to healthy eating can prevent long-term illnesses such as obesity and heart disease. It can even reduce emergency room visits.

Paying for nutrition would likely also lower Medicaid costs in the long term. Food insecurity is linked to higher health-care costs and poorer health outcomes. This is a large reason Americans live shorter, sicker lives than most developed countries even though they spend more on health care per capita than any other nation. It isn’t just about how much money we are spending; it is also about what we are spending it on.

Federal anti-hunger programs such as the Supplemental Nutrition Assistance Program, known as SNAP, are critical to alleviating food insecurity, but they exist outside the health-care system and thus cannot be used to address our chronic health issues. They also are subject to federal and state eligibility requirements and limitations — and would need an act of Congress to be expanded.

Medicaid, by contrast, has a proven track record with experimentation. Some of the most important advances in home- and community-based care, tele-maternity care and more have come from the program.

Imagine what could happen if people with poor health didn’t also have to worry about getting enough nutritious food. Imagine if, in addition to prescribing medications, doctors could prescribe healthy meals. Even the best health-care services and innovative treatments are insufficient — and could in fact be wasted — without integrating food into the health-care experience.

Medicaid can help make that happen. The U.S. health-care system is skewed toward paying for widgets and gadgets and procedures to care for people who are already sick. It’s time to ensure our resources are geared toward what people need to live healthy lives — and start investing in health.