The future of nutrition interventions in Medicaid

Poor nutrition is now the leading cause of global morbidity and mortality, surpassing deaths caused by smoking. Clinical interventions that provide healthy food to prevent and manage chronic disease—sometimes termed food is medicine (FIM)—have emerged as promising innovations. Food insecurity, meaning uncertain access to the food needed for an active healthy life, is a common barrier to healthy eating in the US and is strongly linked to poor health. FIM programs often, but not always, address food insecurity as part of a clinical management strategy. FIM programs are individual-level clinical interventions to improve dietary intake to prevent or treat specific health conditions. This focus distinguishes FIM from federal nutrition programs like the Supplemental Nutrition Assistance Program (SNAP), which promotes population-level food security for low-income households. Given the importance of nutrition in disease management, it is crucial to support FIM innovations within Medicaid, which has emerged as a major pathway for FIM in the US. We argue that there are 2 mistaken perspectives threatening these FIM programs: (1) the underrecognition of nutrition as a core, biological component of clinical care and (2) the view of clinical FIM interventions and federal food assistance programs as substitutes for each other, rather than complementary strategies to advance health.