Improving access to healthy food through the use of Section 1115 waivers

Introduction

Many non-medical factors, especially what a person eats, have a direct impact on their health and quality of life. In the US, more than 47 million Americans live in food-insecure households. The most recent data from the USDA reports that for 2023, the food insecurity rate was 13.5%, a notable increase from 12.8% in 2022. Additionally, an unhealthy diet is a major risk factor for a range of chronic diseases, including cardiovascular diseases, cancer, diabetes, and other conditions linked to obesity. Not only does food insecurity have significant negative impacts on physical health, such as malnutrition, chronic diseases, and a weakened immune system, it also negatively impacts an individual’s mental health, leading to depression, anxiety, and cognitive difficulties. 

Furthermore, food insecurity often leads to individuals consuming unhealthy food, such as processed or fast food. This can be due to low-income and minority populations historically having more limited access to healthy foods and living in a higher density of fast-food restaurants and convenience stores. Nutritious foods, like fruits, vegetables, and lean meats, are often more expensive and require more time to prepare than processed, packaged foods. These packaged foods are also high in refined grains, added sugars, and added saturated/trans fats. Additionally, members of lower-income households less frequently cook dinner at home due to time constraints, which is also associated with lower diet quality. This diet can lead to poor health outcomes and the development of chronic diseases, such as hypertension, hyperlipidemia, and diabetes.

Initiatives to Address Unhealthy Food in America

Health insurance plans, particularly certain Medicare Advantage and Medicaid plans, provide healthy food access through a variety of programs. One way plans can do this is through Section 1115 waivers, which gives the HHS Secretary authority to approve experimental, pilot, or demonstration projects that promote the objectives of the Medicaid and CHIP programs. Under this authority, the Secretary can waive certain provisions of the Medicaid law to give states additional flexibility to design and improve states’ programs. Existing programs include the “Food is Medicine” 1115 waivers, which aim to improve overall health, manage chronic conditions, and reduce healthcare costs. There are currently 12 approved waivers for nutritional support, with two currently pending approval. Through the use of authorized health-related social needs (HRSN), these services can help with nutrition support among those who lack the resources to afford healthy food. Approved nutrition services include nutrition counseling, home-delivered meals or pantry stocking, nutrition prescriptions, and grocery provisions.

HHS Secretary Kennedy has pledged to increase access to nutritious foods through his “Make America Healthy Again” agenda. However, the current administration has rescinded previous Biden-era guidance on HRSNs, phasing out funding for Designated State Health Programs. Removing federal funding prevents states from receiving matching funds to support safety-net health services for low-income individuals, like those provided by 1115 waivers. Additionally, under the current administration, CMS approved waiver extension requests for up to 10 years, a significant increase from the previous three-to-five year approval period. Since the changes to Section 1115 rules, states across the US will need to adjust their waiver renewals to align with the federal government’s policy goals. This effort will vary by state, as states like New York with more generous benefits will most likely need to cut programs.