From progress to peril: Food insecurity screening, social care integration, and a path forward

Over the past decade, the U.S. healthcare system has made significant progress toward integrating food insecurity (FI) screening and intervention into clinical care. Validated tools, Medicaid Section 1115 Demonstration waivers, quality measures, and a growing evidence base for Food is Medicine (FIM) interventions established a still-nascent but promising infrastructure for addressing health-related social needs (HRSNs). Beginning in 2025, however, a convergence of federal policy actions — including the rescission of CMS HRSN 1115 waiver guidance, the removal of social determinants screening quality measures, the codification of restrictive budget neutrality requirements, and approximately $1 trillion in Medicaid cuts — has threatened this progress. At the state level, North Carolina’s Healthy Opportunities Pilots were defunded despite favorable evaluation results, while Massachusetts narrowed HRSN nutrition service eligibility to patients experiencing very low food security. The current administration’s Make America Healthy Again agenda, though rhetorically embracing nutrition as central to health, has simultaneously dismantled the delivery mechanisms for reaching food-insecure populations. This brief examines the scope and consequences of these policy changes, presents the economic case for reversing course, and proposes a four-pillar “Project 2029” agenda for restoring and strengthening the integration of social care into healthcare.