With the roll-out of CalAIM initiatives underway, one of the key items on the menu of optional Community Supports (formerly known as In Lieu Of Services (ILOS)) that are meant to improve whole person health for Medi-Cal enrollees, is medically supportive/medically tailored meals.
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Organizations like the San Francisco Planning and Urban Research Association (SPUR) have been advocating to designate medically supportive food and nutrition services as a covered Medi-Cal benefit since 2019.
Katie Ettman, food and agricultural policy manager at SPUR, said covering medically supportive food and nutrition services under Medi-Cal was a critical first step to implementing medically supportive food interventions across California. These services include medically tailored meals, medically supportive meals, food pharmacies, medically tailored groceries, medically supportive groceries, produce prescriptions, and behavioral health coaching.
“The idea here is that we want physicians to be able to target the appropriate intervention to the appropriate person and give them the flexibility to do that. Because it might make sense for a renal patient who’s been admitted to the hospital to have medically tailored meals delivered to their home once they’re discharged,” said Ettman. “Maybe for someone with uncontrolled diabetes, they don’t need meals delivered to their house, but they do need additional support to get fruits and vegetables, and so it might be better for them to get a produce prescription so that they can go shop at a retail store.”
She added that addressing this particular social determinant of health was especially important, as patients with diet-sensitive chronic conditions like diabetes and cardiovascular disease, who are also at high-risk of COVID-19, are struggling to access healthy food during the pandemic. Since 2018, food insecurity rates in California have nearly doubled, reaching 25.3% as of July 2020.
Ettman emphasized the need to include healthy food as a Medi-Cal service in order to help providers treat and prevent chronic disease and ultimately improve community health outcomes.
“The agency [of providers] is necessary there. Maybe [a patient] has screened positive for food insecurity, and for so many physicians, they don’t have anything that they can provide. They’ve identified that [the patient] is food insecure, which we know affects their health, and then there’s no intervention to back them up. And so by fully integrating different medically supportive food and nutrition services into healthcare, we give doctors, nurses, and physicians the opportunity to truly answer the call when someone says they’re in this situation.”
She said SPUR is currently working on getting more managed care organizations to opt into providing the medically supportive food and nutrition services (18 of the 22 currently offer them), since CalAIM Community Supports are optional. Additionally, she said SPUR would be helping community-based organizations that provide medically supportive food and nutrition services navigate the complicated contracting process.
Ettman said the ultimate goal would be to establish these services in California for the long-term.
“Once we get health plans to opt in, we [need to] make sure that we have all of the appropriate data necessary and we know the right people to transition [those services] to a state plan benefit. When the waiver is over, the services will be at the end of their lifespan, and we want to make sure that they become permanent. So the other thing we’re doing this year is trying to figure out how we can best support and advocate for helpful evaluation that sets us up for success and transferring that to a permanent benefit.”
She also mentioned that since there is currently no federal or national code for produce prescriptions or food pharmacies, SPUR would be working with the state of California and national partners to fully integrate all of these medically supportive food and nutrition interventions into the coding and billing system this year.