Food Access, Nutrition And Public Health In The Senate Farm Bill

The Senate released its draft of the 2018 Farm Bill on Friday, June 8th. This post analyzes how the Senate Farm Bill addresses FBLE’s goals and recommendations from its report, Food Access, Nutrition, and Public Health. The Senate Agriculture Committee moved the Agriculture Improvement Act of 2018 (S. 3042) out of committee on June 13th. The Senate is voting on S. 3042 this week.  

Protecting and Strengthening SNAP

Maintain SNAP’s Ability to Adapt to Changes in the Economic

Conditions

The Agriculture Improvement Act of 2018 preserves the Supplemental Nutrition Assistance Program (SNAP) in its current form. By leaving the nation’s key anti-hunger program largely unchanged, SNAP will continue to serve those low-income Americans who are currently eligible to receive benefits. Specifically, in contrast to the farm bill that passed the House last week, S. 3042 would not expand work requirements for SNAP. Although FBLE recommends eliminating all work requirements that apply to “able-bodied adults without dependents” (ABAWDs) between the ages of 18-49, the Senate bill avoids putting SNAP even further out of reach for those who rely on it.  

FBLE is optimistic that additional provision in the Nutrition title will begin to address disparities between states in the quantity and quality of employment and training programs. The 2014 Farm Bill included SNAP Employment and Training (SNAP E&T) operation requirements for states surrounding job searches for unemployed individuals. The Senate bill will enhance these operations by allowing states to continue using effective SNAP E&T pilots that were authorized in the 2014 Farm Bill. Further, the Senate bill modifies the current SNAP E&T operations. These modifications to the work-related pilot projects are meant to meet the needs of individuals who are seeking work but face barriers to employment such as physical condition and personal situation when applying for a job. The Senate bill provides $185 million in addition funding to serve individuals who are struggling with barriers to employment for each fiscal year from 2019-2020. These programs are meant to assist in combating these barriers, but participation in work programs are not tied to receipt of benefits.

Enhance and Improve SNAP to Address Food Insecurity,

Revitalize Local Economies, Improve Access and

Efficiency Through Technology, and Remove Ineffective Barriers

to Food Access

While S. 3042 makes no cuts to SNAP, neither does it strengthen the program’s ability to meet its core responsibility of providing access to an adequate diet. For example, the bill does not follow FBLE’s recommendation to raise benefit levels, which currently are insufficient to meet beneficiaries diet and health needs.

However, the bill does take some steps toward utilizing technology tools to help SNAP participants. One issue SNAP applicants have is that SNAP is an income-based eligibility program. This leads to many beneficiaries having a difficult time proving their income and receiving their benefits. These challenges often result in people losing benefits, extended cost the government, and other confusion.

However, the S. 3042 takes steps to ease the barriers to entry for SNAP, by promoting cost effective and more efficient tools to verify earned  household or individual income for those receiving SNAP benefits. Further, the Senate bill instructs the USDA to allow Electronic Benefit Transfer (EBT) at farmers’ markets so that  SNAP participants can redeem benefits at multiple locations and support local food options. In its’ current form the current EBT system is often unreliable and is not always available for participants to use, therefore preventing people from getting the food they need.

Improving Public Health and Access to Nutritious Foods

Strengthen Food Assistance Programs that Promote Healthy

Choices among SNAP Participants

FBLE supports the Senior Farmers Market Nutrition Program (“SFMNP”), which awards states grants in order to provide vouchers to low-income seniors so that they can purchase foods (fruits, vegetables, honey, and fresh cut herbs) at farmers’ markets, roadside stands, and CSAs. S. 3042 would reauthorize SFMNP with $20.6 million per year in funding. Although the bill does not devote additional resources to the program, the bill would also ease the paperwork and office visit requirements on participants who are seniors or people with disabilities. This aligns with FBLE’s recommendation to strengthen SFMNP by helping to ensure that seniors receive assistance that can improve their access and health.  

FBLE also support the Food Insecurity Nutrition Incentive Program (“FINI”), which is currently a grant program that funds projects that aim to increase the amount of fruits and vegetables SNAP recipients purchase. FINI has been renamed “The Gus Schumacher Food Insecurity Nutrition Incentive Program.” FINI has been successful which led to its reauthorization and increased funding of $50 million per year, which is more than double the $100 million FINI received over the previous five years combined. FINI has also been authorized as a mandatory permanent program. This supports FBLE’s mission to devote additional resources to this program and ensure that low-income households are able to purchase nutritious food.

However, FINI is not everywhere and there needs to be improvements to the information and technology sharing across various FINI projects. FINI is often used as a pharmacy programs in states and is also used on other programs that are straight incentives for fruits and vegetables not tied to the healthcare system in any way directly.

Improve Health Outcomes of Low-Income Individuals Living with

Serious Diseases by Establishing a Food is medicine Pilot

In a farm bill first, S. 3042 embraces the concept of “Food is Medicine.” Food is Medicine describes the provision of nutritious food tailored to the medical needs of an individual who lives with one or more health conditions likely to be affected by diet, such as diabetes, heart disease, certain cancers, and HIV.

FBLE’s proposes a Food is Medicine pilot program that supports and evaluates using medically-tailored meals to support the health of low-income individuals living with diseases. The Harvesting Health Pilot Program is a positive initial effort to connect low-income patients with fresh fruits and vegetables. However, this pilot does not provide meals or other types of food, and therefore is too narrow. A recent study found that a 16% net reduction in monthly healthcare spending for individuals receiving home delivery of medically tailored meals.

The Senate bill does not adopt FBLE’s approach, but takes a first step by creating the Harvesting Health Pilot Program, a $4 million program that receives funding each year and will be administered from 2019-2023. Under the program, the Produce Prescription Pilot will provide fresh fruits and vegetables to members through financial/non-financial incentives in order for members to purchase/procure fresh fruits and vegetables.

Eligibility for the program includes nonprofit organizations or state or units of local government. Further these groups are required to partner and involve a Health Care Program (hospitals, FQHC, healthcare provider groups, VA clinic) in the development of their “produce prescription” effort. In order to receive benefits, individuals must be receiving benefits from SNAP, Medicaid, or be a member of a low-income household that suffers from, or risks developing “a diet-related health condition.” There is also a broad requirement for members to provide educational resources on nutrition to members who receive benefits.

Evaluation and administration provides data to support the long term success of Food is Medicine initiatives. FBLE recommends “rigorously evaluation” of any Food is Medicine pilot program, which probably requires an amount greater than the 10% cap on program evaluation allowed by the Harvesting Health pilot.

Looking Ahead

Overall, S. 3042 is a bipartisan effort that rejects the partisan approach taken by the House bill and aligns much more closely to FBLE’s Food Access, Nutrition, and Public Health recommendations. In fact, the bill takes important steps forward by including pilot programs that continue to assist low-income and sick individuals. Moving forward, protecting the scope and scale of the food safety net will be a contentious issue as the Senate bill passes and the farm bill process moves into conference committee, where differences between the House and Senate versions will be negotiated. FBLE will be watching the process closely, so stay tuned.

Improving Health Outcomes While Curbing Costs with Medically Tailored Meals

On May 9th, 2018, CHLPI, the Food is Medicine Coalition, Tufts Friedman School of Nutrition Science & Policy, and the House Hunger Caucus’ Food is Medicine Working Group, brought together an expert panel for a discussion on improving health outcomes and curbing costs with medically tailored meals.

Health and food are fundamentally linked. For people who are living with chronic illnesses, or have critical medical conditions, nutritious food is essential to maintaining and regaining health. Congressman Jim McGovern of Massachusetts, a founding member of the Food is Medicine Working Group, opened the briefing by addressing the nation’s lack of a comprehensive-coverage of medically tailored food and nutrition within healthcare. The Ryan White HIV/AIDs program is the only federally funded program for medically tailored meals. “The support through the program has enabled organizations across the country, like God’s Love

We Deliver in New York City and Community Servings in my home state of Massachusetts, to carry out their missions of providing nutritious food to those in need,” said McGovern. “Now the organization is serving a much broader population and federal funding should reflect that.”  McGovern hoped that leaders of the working group are able to “think concretely about what we could do at a federal level to advance this cause.”

Noting that 5% of the Medicaid population consume roughly 50% of healthcare costs, the briefing brought food and nutrition to the center of the conversation about healthcare delivery and financing. In an environment of rising healthcare costs and tight budgets, expert panelists discussed how an integration of medically tailored meals into public and private health insurances will not only improve health outcomes but also significantly reduce healthcare costs.

 Our Food:  The #1 Cause of Poor Health

“Food is the single biggest cause for poor health in the U.S.,” said Dr. Dariush Mozaffarian, Dean of Tufts Friedman School of Nutrition Science & Policy. Diet-related diseases, such as cardiovascular diseases and type 2 diabetes, can each cost up to $300 billion per year in direct health care, causing enormous economic burdens. Healthy and appropriate medically tailored food can not only prevent these fatal diet-related medical conditions but also substantially reduce the amount of dollars spent on healthcare each year.

Karen Pearl, President & CEO of God’s Love We Deliver, defined medically tailored meals (MTMs) as a highly specialized healthcare intervention that is managed by a Registered Dietary Nutritionist (RDN) and designed based on evidence-based practice guidelines to address specific complex health conditions of the individual. God’s Love We Deliver has served 1.8 million medically tailored meals per year to seven thousand people in the state of New York. “Nutrition has the ability to fight disease and help people dealing with life threatening illnesses,” said Pearl. “You can feed somebody medically tailored meal for a half of a year for the price of the night in a hospital.”

A recent-released study conducted by Dr. Seth Berkowitz, Assistant Professor of Medicine at the University of North Carolina School of Medicine, demonstrated strong positive results for high healthcare utilizing participants who received medically tailored meal intervention. Dr. Berkowitz reported that over an average of 18 months of follow-up, participants showed a decrease of 70% in emergency department use, a 50% cut in hospitalization rates, and a reduction of $220 in healthcare costs per month.

Bill George, President & CEO of Health Partners Plans, shared similar results from a program for diabetic patients who received Medical Nutrition Therapy in the form of medically tailored meals. Patients who received medically tailored meals three times a day, seven days a week for six to 18 weeks experienced a reduction of 19% in medical costs per month, as well as decreases in inpatient admission and emergency room visits by 26% and 7%, respectively. “We’re here to advocate that Food is Medicine become supported by the federal government,” said George. “But more largely, what I’m trying to advocate is for people to realize that traditional ways of managing medical conditions don’t always work, because of social determinants of health.”

For medically-complicated individuals, simply providing resources to purchase food may not be enough. Medically tailored meals can fill the gap in existing interventions for those who require a more complex healthcare delivery system. Food and nutrition innovation is essential for the future of healthcare. The inclusion of a comprehensive-coverage of medically tailored meals at the federal level maximizes opportunities to meet the needs of people living with severe medical conditions, lower healthcare costs, and improve health outcomes.

Robert Greenwald, Faculty Director of Harvard Law School’s Center of Health Law and Policy Innovation, outlined key measures that Congress must take to transform the healthcare delivery system. For example, Congress must urge the Centers for Medicare and Medicaid Services (CMS) to test the impacts of medically tailored meal on Medicare and Medicaid by launching a rigorous demonstration program. Additionally, Congress must clarify and expand Medicare and Medicaid coverage of medically tailored meals to alleviate the suffering of people living with chronic illnesses.

“For people living with chronic and serious health conditions, what should be clear is that health and food are inextricably linked,” said Greenwald. “For those people that have chronic and serious health conditions, unhealthy and inappropriate food is poison. Medically tailored meals, on the other hand, are food is medicine.”

CHLPI will work with Congressman McGovern and other congressional champions to advance the integration of medically tailored food nutrition into healthcare. Please check back for updates and watch the Briefing here!

Food is Medicine: Addressing Hunger as a Health Issue

On January 17, 2018, CHLPI’s Faculty Director, Robert Greenwald, spoke at the Food is Medicine: Addressing Hunger as a Health Issue panel discussion. The briefing kicked off the launch of a new bipartisan Food is Medicine Working Group within the House Hunger Caucus.

For over a decade, the bipartisan Hunger Caucus has served as a forum for Members and staff to discuss, advance, and engage the House’s work on national and international hunger and food insecurity issues. This year the Caucus builds upon its foundation
to bring into focus the impacts of hunger on our nation’s health. 

The event’s panel included:

• Dariush Mozaffarian, MD, DrPH
  Dean, Tufts Friedman School of Nutrition Science & Policy; Jean Mayer Professor of Nutrition and Medicine

• Robert Greenwald, JD
  Faculty Director, Center for Health Law and Policy Innovation; Harvard Law School, Clinical Professor of Law

• Kathleen Merrigan, PhD
  Director, GW Food Institute; The George Washington University, Professor of Public Policy

• Karen Siebert
  Advocacy and Public Policy Advisor, Harvesters – The Community Food Network on behalf of the Feeding America network

Congress members Jim McGovern, Lynn Jenkins, Chellie Pingree, and Dr. Roger Marshall were all on hand to lend their thoughts on the importance of the Food is Medicine movement.

Quotes from  Food is Medicine: Addressing Hunger as a Health Issue:

• Congressman Jim McGovern – “My hope is that this working group is going to be about more than just talk, it’s going to be about action.”

• Congresswoman Chellie Pingree – “Every conversation we have connects health outcomes to what we eat. I think it seems only logical that we should be talking about this as a policy issue. Whether it’s medically tailored meals or prescriptions for fruits and vegetables, there are a lot of good ideas out there.”

• Robert Greenwald – “We need to start to integrate Food is Medicine into more mainstream Medicare and Medicaid programs particularly given the growing body of research that demonstrates how cost saving and not just cost-effective medically tailored meals are.”

View a recording of the congressional briefing on Facebook.

View CHLPI’s slides from the congressional briefing.

Massachusetts food is medicine state Plan

Massachusetts Food is Medicine State Plan Planning Council Serves up Official Launch to Expand Nutrition Interventions for Vulnerable Populations Across the Commonwealth

On October 30th, the Massachusetts Food is Medicine State Plan Planning Council kicked off the official launch of its work to help reduce the cost of care, expand access to nutrition, and improve health among vulnerable populations by advancing the Massachusetts Food is Medicine (FIM) State Plan.

The FIM State Plan Project is led by the Center for Health Law & Policy Innovation (CHLPI)of Harvard Law School and Community Servings, a non-profit leader in nutritional healing. The Project seeks to accomplish several critical goals over the next year in order to move the FIM work forward, which include:

1. Identifying areas of need for FIM services;

2. Assessing access to FIM services in Massachusetts;

3. Publishing a report on the status of FIM need, access, and recommendations for FIM expansion.

To accomplish these goals, FIM Project leaders are embarking upon a multi-pronged approach to engage stakeholders, gather high-quality data, and develop a blueprint for concrete policy solutions. This blueprint will be adopted as the Massachusetts Food is Medicine State Plan and used to scale up FIM services throughout the Commonwealth.

Key knowledge, insights, and advisement to the Project are provided by the Massachusetts Food is Medicine State Plan Planning Council; a diverse, interprofessional coalition of health care providers, community-based agencies, insurers, and professional, academic, and policy organizations. The Council’s membership includes representatives from across the distinct geographic regions of Massachusetts. These members steward dozens of local and statewide organizations and provide interdisciplinary activities in health policy, research, clinical practice, human services, and community action. During the inaugural meeting, members convened for the first time to discuss strategies and identify steps for operationalizing this year’s FIM goals.

After the kick-off meeting, several Planning Council members presented at the 5th Annual Food is Medicine Symposium, held at Wasserstein Hall on Harvard Law School’s campus. Both Dr. Kathryn Brodowski, Senior Director of Health & Research at the Greater Boston Food Bank, and Sue Joss, CEO of Brockton Neighborhood Health Center, emphasized in their talks the vital importance of relationships among health care providers, communities, and businesses to address nutritional needs. Browdowski cited innovative clinical partnerships to achieve better patient outcomes, while Joss highlighted the advancements her clinic has made since co-locating with Vincente’s local family-owned grocery, which provides culturally and socially competent food products and services to residents.

For updates on the Massachusetts Food is Medicine State Plan and opportunities to provide feedback, visit the FIM State Plan page on CHLPI’s website, check back here for updates on our blog, and sign up for the FIM State Plan email list here or by contacting Katie Garfield, Staff Attorney and Planning Council Co-Leader, at kgarfield@law.harvard.edu. 

New Report on HIPAA and Food Banks Mentioned in The New Food Economy

On March 30, 2017, The New Food Economy published the article “As Veggie Prescriptions Gain Traction, Food Banks Prepare to Personalize Nutrition—and Protect Privacy,” which references multiple reports from CHLPI’s Food is Medicine initiative.

The article, written by Claire Brown, looks at the importance of including healthy food in treatments to combat and control type 2 diabetes and obesity, and the role food banks can play in cooperation with hospitals and health care providers. The article also describes CHLPI’s latest report, “Food Banks as Partners in Health Promotion: How HIPAA and Concerns About Protecting Information Affect Your Partnership,” as “a roadmap for getting healthy food to the people who need it without compromising their privacy.”

Excerpt from article:

“Still, doctors have been “prescribing” fruits and vegetables since at least 2013. In some cases, that looks like coupons for the farmers’ market outside the hospital. At least one health insurance company arms its customers with digital coupons that incentivize healthy purchasing. Some of these initiatives seem like lip service, sure. But there’s evidence of a paradigm shift in health care—one that means a “Veggie Rx” might soon mean a lot more.”

Read the full article “As Veggie Prescriptions Gain Traction, Food Banks Prepare to Personalize Nutrition—and Protect Privacy.”