Food insecurity is compounded by social determinants of health, but there are government infrastructures and federal funding measures in place that help healthcare address food insecurity and improve overall health and well-being.
Having safe, consistent, and reliable access to healthy foods is a privilege, one shaped by numerous social, economic, and political factors. Those without such privileges are experiencing food insecurity. Nearly 44 million Americans in 2022 faced uncertainty of where their next meal would come from.
Compounding this growing crisis are social determinants of health (SDOH), such as economic instability, unsafe housing, or inadequate healthcare. All these factors cause significant negative contributions to people’s health and wellbeing, necessitating cross-sector partnerships for equitable improvements in people’s health and living environments. This includes partnerships between for-profit businesses, non-profit organizations, and educational institutions. Other critical partners for these solutions are federal, state, and local government agencies.
Vital Conditions Framework
The Vital Conditions for Health and Wellbeing Framework is a powerful guiding tool for SDOH interventions, as it defines the properties of places and institutions that we all need all the time to reach our full potential, like food, humane housing, access to meaningful work, sufficient income, and a sense of belonging.
Image Source: Vital Needs and Conditions, 2022 https://health.gov/our-work/national-health-initiatives/equitable-long-term-recovery-and-resilience/framework
As the core framework leveraged in the Federal Plan for Equitable Long-Term Recovery and Resilience (Federal Plan for ELTRR), the proposed 78 recommendations allow for the organization and structural alignment between federal agencies so they may work together to develop a comprehensive, community-focused federal response to major social determinants of health and associated health inequities.
The second Vital Condition, Basic Needs for Health and Safety, includes a subsection for Nutritious Food and Safe Water. Recommendations to increase access to safe food include using federal funds to catalyze urban agriculture and federal food assistance programs. Cited inter-agency collaboration for this initiative include the Center for Disease Control (CDC), Environmental Protection Agency (EPA), and Department of Health and Human Services (HHS). The focus of these collaborations is to align government agencies to develop solutions which promote these vital conditions as a catalyst for resilience, resulting in thriving communities.
A Funding Model
Accompanying the interagency collaboration made possible by the Federal Plan for ELTRR, Medicaid expansion is expected to enhance health outcomes and promote equity across various demographic groups, particularly in rural areas facing challenges. Providers are increasing their focus on Health-Related Social Needs (HRSN), or unmet social and economic needs that contribute to poor health and well-being, often resulting from underlying community.
As of 2022, Centers for Medicare and Medicaid Services (CMS) announced that HRSN can be covered by Medicaid Waiver 1115. This waiver allows states to waive certain federal rules and use Medicaid resources to design and test experimental approaches directly addressing SDOH by establishing transformative and equitable HRSN services. This is further outlined in CMS’ 2022-23 Framework for Health Equity.
The five main priorities of this initiative include:
Expand the Collection, Reporting, and Analysis of Standardized Data
Assess Causes of Disparities Within CMS Programs and Address Inequities in Policies and Operations to Close Gaps
Build Capacity of Health Care Organizations and the Workforce to Reduce Health and Health Care Disparities
Advance Language Access, Health Literacy, and the Provision of Culturally Tailored Services
Increase All Forms of Accessibility to Health Care Services and Coverage
Some states are demonstrating early innovative uses of this expansion, particularly focusing on nutrition. For example, in 2022, Arkansas was approved to provide intensive care coordination, housing, and nutrition support through their Life360 HOMES, with an emphasis on rural, maternal, and at-risk youth health. Massachusetts and Oregon will be testing evidence-based nutritional assistance and medically tailored meals to address diet-related diseases and disparities.
Pennsylvania Medical Assistance Program
Pennsylvania’s Medicaid 1115 Waiver application was submitted in January 2024, titled “Bridges to Success: Keystones of Health for Pennsylvania”. Not yet approved, this proposed program targets re-entry after incarceration, housing, food & nutrition, and continuous coverage for children under the age of 6. The proposed HRSN services related to nutrition focus on populations with diet-sensitive health conditions, including medically tailored meals and groceries, delivered pregnancy and postpartum grocery boxes, and application support and navigation services for SNAP.
Health Care’s Role in Addressing Food Insecurity
A growing recognition of social determinants of health across federal and state lead to more robust collaboration and funding frameworks, health care has an increasing role in addressing food insecurity, a core health-related social need and vital condition. Addressing disparities in access to food and improving health outcomes leads to healthier communities and a more equitable healthcare system overall. With 11 states, including Pennsylvania, pending for Waiver 1115 approval, expect to see an increasing role of health care mechanisms in nutritional assistance.
To cite: Hygieia Consulting. (2024) A Deep Dive on Health Care & Food Insecurity. hygieia.llc
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