More than 15 percent of Texas adults were food insecure between 2020 and 2022, according to the U.S. Department of Agriculture. Food insecurity is related to a variety of negative health outcomes. Leaders in the healthcare continuum discussed options to increase food security at the 2024 Texas State of Reform Health Policy Conference on February 27.
Rachel Cooper, director of health and food justice at Every Texan, said the Medicaid unwinding process has affected food security.
Texas is currently experiencing a backlog in Supplemental Nutrition Assistance Program (SNAP) applications. The Texas Health and Human Services Commission (HHSC) processes both Medicaid and SNAP applications, and the agency does not have enough staff or funding to complete them in a timely manner, Cooper said.
“We chose to do what congress requested at a much faster and unrealistic pace than what is necessary,” Cooper said.
According to Every Texan, 37 percent of SNAP applications in the state are delayed.
Rachel Koay, chief impact and equity officer at Feeding Texas, said organizations like hers are not meant to be the state’s food safety net. They do not have the infrastructure required to feed everyone in need.
“Anecdotally, it’s very common to hear families are waiting three to six months for their SNAP application to be approved. In terms of quantity for a household, that’s about 1,000 meals [they miss out on], and often these families rely on SNAP as part of how they feed their families on a regular basis.”
— Koay
Texas also opted out of the new Summer EBT program, which provides families in need with $40 per month per eligible child during the summer to support childrens’ nutrition needs while they are not in school. Texas chose to opt out due to HHSC being overwhelmed by the SNAP backlog, leaving the state with insufficient capacity to take on another program.
Tanweer Kaleemullah, director of policy and research at Episcopal Health Foundation (EHF), said he feels collaboration is vital to build an effective system to address social determinants of health (SDOH), including food insecurity.
“There are so many organizations I know that are doing food access that have no idea what anybody is doing,” Kaleemullah said.
CareSource Bayou Health is working to acquire community partners to address food insecurity. Lindsay Lanagan, vice president of government relations and a compliance officer with the organization, said her clinics partner with the Houston Food Bank to provide patients with healthy food through Food RX.
“We screen patients, we prescribe healthy foods, and then the food bank brings out a mobile market that’s only full of whole foods and vegetables,” Lanagan said.
Lanagan said a prime, but often missing partnership has to be formed between managed care organizations (MCOs) and care providers. She believes food security is an issue that should be addressed by physicians directly with their patients.
Cooper said Every Texan works with a variety of community partners—including schools, religious groups, and community health centers—to increase food access.
Every Texan also collaborates with other groups to ensure people have access to services in a variety of languages, and helps enroll people in Medicaid, SNAP, the Children’s Health Insurance Program, and school lunch services.
Cooper also emphasized the importance of choice in nutrition programs.
“A lot of what we decide other people should eat isn’t what they might eat for whatever reason (cultural, religious). There are lots of things that people are not familiar with and will not eat. Giving people the control that we all use in our own lives, treating people like adults and letting them make their own choices, we think is important.”
— Cooper
EHF is working on its strategic plan, which will focus on three major issues: maternal health, diabetes prevention, and food and nutrition security, Kaleemullah said.
Individual decisions—such as choosing to eat healthy foods and exercise— are just as important as SDOH, he said, while noting that the two are tied.
“Individual decisions can be constrained by life situations, but how can you also influence that?” Kaleemullah asked.
Kaleemullah cited diabetes prevention as an example, which can be affected by SDOH and individual decisions. He said EHF is examining ways to influence both policy and community level factors so people have access to services that could allow them to make better individual decisions for their health.
Lanagan said funding food security programs as part of the healthcare system is necessary if the organizations and programs providing food are to continue moving forward.
“One of the biggest levers we’re missing is reimbursement for this work,” Lanagan said. “If we don’t acknowledge that, that would be a very bad thing.”
Lanagan highlighted recent legislation that now requires Medicaid MCOs to reimburse for case management for pregnant women (CPW) services. CPWs—similar to community health workers (CHWs)—provide non-medical support to pregnant people in health systems, like coordinating transportation to their appointments, finding them healthy food, and ensuring patients engage with the care continuum.
CareSource Bayou Health is fortunate to have funding to provide its patients with CHWs, Lanagan said. AmeriCorps awarded a grant to CareSource Bayou Health to pay for CHWs.
“We just got our grant doubled,” Lanagan said. “We’re going to have 100 people in our 57 clinics to basically serve as CHWs.”
Health plans play a major role in expanding access to healthy food as well. Kaleemullah said many health plans are considering ways to expand their services, but that is often difficult because the support is not there.
“The health plans are definitely there,” Kaleemullah said. “I would say that, maybe rightfully so, they need a branch to step out on. And right now, Texas doesn’t have a tremendous amount of branches.”
Koay cited a need for incentives for organizations to explore sustainable nutrition solutions.
“What are the incentives that are going to make the path forward really clear so all of us can find a sustainable solution?” Koay asked.