Promising Practices Among States

State partners identified the value of connecting dots across services, people, and providers. They identified that FIM can:

• Enable connection between health care and health-related social needs (HRSNs) via community-based organizations. 
• Support connection across state agencies to find overlapping or compatible services, creating opportunities for Medicaid to be more efficient in the provision of services. 
• Catalyze new collaborations and partnerships, including individuals with lived experience.  
• Provide greater connectivity between health care providers and patients by:
  • Getting more people in the door and allowing providers to address other complex HRSNs
  • Initiating follow-up services to meet food insecurity needs in culturally relevant ways up front while addressing as many HRSNs as possible during appointments
  • Instilling greater patient trust of the health care system

• Covered benefit for certain Medicaid beneficiaries
• Accessible to anyone with aligned need
• Part of an integrated system of care within and across systems 
• A priority for policy makers and health care professionals 
• Component of preventative medicine, and as part of the broader health-related social needs movement 

FIM has brought food to many who need it and has connected the dots to other HRSNs, but obstacles remain. Some FIM initiatives still target only the sickest patients and create those linkages to other services. This can be expanded to reach broader populations in need.  

Many social drivers of health services remain siloed, and it is challenging to knit them together. Practicalities regarding how programs are delivered and existing challenges within current systems can be obstacles to integration.  

The leadership of community-based organizations (CBOs) is central to successful FIM interventions. State partners noted that additional funding, capacity, and infrastructure are needed to invest in strong structures with sustained value. 

Leadership and investment from the federal government, state government, and local payers can support greater connection and lead people toward CBO partners, creating new paths to service delivery.  

This shift moves the work from food provision as a charitable model to food provision as a health care model and health intervention. Making this philosophical and operational shift includes capacity building for CBOs via 1115 demonstration pilots and managed care plans to prepare them to successfully operate within in a fee for service environment. 

State partners suggested strong practices to enable greater CBO leadership:  

• Provide infrastructure funding that can help bring nutrition organizations in alignment with health care requirements to become an enrolled provider in Medicaid. 
• Enlist partners to help inform and guide development of 1115 demonstration pilots to strengthen CBO capacity. 
• Build funding into the 1115 demonstration pilot authority to put toward CBO capacity building while providing technical support to CBOs via network leads. 
• Account for CBO administrative costs and ensure that all community partners can engage in administrative resources and afford costs.
• Provide more state infrastructure funding for states not operating on 1115 demonstration pilots and alternately operating through Medicaid managed care in lieu of services and settings.
• Provide technical assistance via webinars and other means including building budgets, program design, HIPAA requirements, and other operating structures. 

By broadening the lens, there is an opportunity to shift to a system of care that provides healthy food. State partners specifically reaffirmed the value of leveraging the breadth of aligned federal benefits, especially those that relate to food access, including SNAP and WIC.  

• Build infrastructure across a state so community assets have greater connectivity between social services and health care resources.
• Leverage the local food system to attract health care dollars and ultimately drive economic stability and growth in communities. 
• Collaborate to support the development of definitions and use of FIM-intervention-quality disease-specific nutrition standards to ensure accountability in FIM.
• Ensure state agencies, especially Medicaid agencies, have FIM subject matter experts to call on so that services provided can meet overall FIM goals. 
• Work to align on and advance a national consensus on service definitions and standardized billing codes to significantly support greater uptake and consistency in a network of care. 

State partners identified that FIM can serve as a key driver of health care transformation within a state in the following ways:  

Prioritize Enhanced Linkages at Scale

FIM offers unique opportunities for state agencies and CBOs to form new connections to address health-related social needs and build a coordinated system with less duplication and more efficient funding. FIM can be a motivating factor in working across state agencies to identify overlapping or compatible services. FIM can merge community health aspirations with existing systems to scale infrastructure among payers, health providers, local federally qualified health centers, CBOs, and grassroots groups.

Address Whole-person Health

FIM is an approach to health that considers physical, behavioral, social, and environmental contexts and views prevention as medicine. FIM can get patients in the clinic door, particularly for services that help with complex needs. FIM interventions can free up patients’ food resources to address other needs, such as housing, transportation, or interpersonal violence.  

Increase Trust in the Health Care System

FIM interventions can be structured by health providers to address patients’ immediate food needs up front during an appointment. Patients and providers can expect successful referrals and experience a greater sense of trust in the health care system. FIM can be a critical first step in a person’s care journey.  

Incorporate Lived Experience

FIM operationalizes and integrates services into health care that both patients and providers want and already understand as being critical to health. FIM is an opportunity to listen to health care providers, many of whom already recognize that food is critical to health, and build the bridges that providers want to see. FIM offers an opportunity to hear lived experience from stakeholders and provide health care services that are culturally relevant and nourishing. 

Contributors represented a range of states at different phases of work and leveraging different implementation structures. Across these perspectives, some promising areas of innovation in state FIM initiatives include the following: 

Leverage Technology-driven Solutions to Maximize Engagement 

Ensure eligible individuals are rapidly enrolled by leveraging integrated data platforms and text messaging to offer information about relevant FIM services. By leveraging technology with low friction including text message, eligible individuals can sign up for FIM services and more immediately connect to community providers and food access. 

Invest in Infrastructure 

Building capacity among CBOs is supported through opportunities to apply for targeted capacity development multiple times. Infrastructure investment in community service providers also includes incentive payment dollars for managed care plans, technical assistance marketplaces with free consultancy services for CBOs or nontraditional providers, and statewide funding collaboratives for nontraditional providers.  

Integrate Funding Across System Partners 

Supporting FIM initiatives through investment sources from federal government, state leaders, and payers make FIM interventions robust and support longevity. Engaging partnership from large, reliable, trusted partners to enable FIM efforts helps build up existing community assets and improve FIM delivery.  

Prioritize Care Integration 

Services are maximized when care is integrated through the provider team. Specifically, utilizing care managers can support patients to navigate across social drivers of health services and sectors. Ensuring FIM is part of the care plan and not siloed facilitates referrals for FIM from providers, which both has higher success rates and can reaffirm FIM in a whole-person health context. Integration can be enabled through use of technology to communicate across social drivers of health services. 

Create Backbone Structures for Learning and Efficiency 

Creating care hubs to provide technical assistance, capacity building, and support for a cross-cutting set of CBOs, regardless of domain or service, may maximize strong implementation network performance. Working through social service integration working groups, a communications forum that allows patients to be referred to different FIM programs, can connect HRSN partners and facilitate social service organizations in the nutrition space to refer to one another. 

To support the success and sustainability of their FIM initiatives, states can:  

• Develop FIM credentialing and nutritional standards to help define accountability. 
• Forge infrastructures that ensure comprehensive medical care. 
• Build coalitions of subject matter experts that can be leveraged to achieve greater consensus on service definitions and ensure FIM services are meeting overarching goals. 
• Create forums for CBOs and state representatives to discuss strategies and challenges. 
• Evaluate FIM interventions based on high-level benchmarks, even during pilot stages, including on quality and price standards.  

Food Is Medicine: A State Medicaid Policy Toolkit 

This toolkit builds upon the 2023 guidance by providing a roadmap for state officials to identify the most feasible and impactful approaches to addressing patient nutrition needs in their state Medicaid and CHIP programs.