Hawaiʻi set to offer nutrition support services to Medicaid patients

Medicaid patients may soon benefit from a five-year federal waiver that allows Hawaiʻi MedQUEST program to use Medicaid dollars to expand services with community-based food and nutrition organizations.

Section 1115 of the Social Security Act gives the Secretary of Health and Human Services authority to approve experimental, pilot or demonstration projects that are likely to advance to Medicaid goals and objectives. The demonstrations aim to give states more flexibility to evaluate state-specific policies to better serve Medicaid populations.

The five-year waiver allows the state of Hawaiʻi to try out new or innovative approaches to delivering healthcare services that differ from what is normally allowed under federal rules. For example, for the first time, Hawaiʻi’s waiver now authorizes Medicaid coverage of “nutrition support services,” acknowledging the widely accepted notion that “food is medicine.”

“ʻFood Is Medicine’ is shorthand for a movement that aims to integrate food and nutrition into the modern healthcare system to prevent, manage and treat various illnesses,” said Daniela Spoto, Hawaiʻi Appleseed director of Food Equity. “Sustaining the community-driven programs that have been advancing this philosophy in the long term will require integrating them into our modern healthcare system. That’s what this waiver helps to achieve.”

“The approval of Hawai’i’s Medicaid 1115 waiver is a transformative step in connecting healthcare with local food systems,” said Lucas McKinnon, managing director of Hawaiʻi Good Food Alliance. “By fostering collaboration among healthcare providers, local community-based organizations, and farmers, we are building healthier communities rooted in ʻāina accountability. Medicaid’s role is pivotal, but this is just the start — we will continue advocating for sustainable funding for locally sourced Food is Medicine initiatives through our Community Care Hub model.”

Services authorized by the waiver include nutrition education, as well as programs that offer the direct provision of food, such as medically tailored meals, produce prescription programs and restocking home pantries. Notably, Hawaiʻi’s waiver is one of the few that explicitly supports local food procurement, reinforcing our communities’ commitment to both public health and local agriculture.

To guide the successful integration of these services, Hawaiʻi Appleseed — with support from the Harry and Jeannette Weinberg Foundation and Stupski Foundation — has released a report titled “Food is Medicine: An Assessment of Hawaiʻi’s Food and Nutrition Services Landscape.”

The report draws on direct feedback from Hawaiʻi community-based food and nutrition organizations to identify both challenges and opportunities for expanded nutrition services in the state. The report provides recommendations for next steps, taking into consideration this local feedback and drawing on models that have been developed in other states:

1. Invest in Community Care Hubs to centralize administrative functions and support community-based food and nutrition organizations in partnering with Medicaid to provide nutrition services. These hubs can streamline referrals, billing, and data sharing between healthcare providers and community organizations.
2. Establish a policy advisory body to oversee the integration of Health Related Social Needs services, engage stakeholders across sectors, offer policy recommendations and ensure alignment with state health goals.
3. Develop cross-sector financial partnerships between public entities and private funders to ensure the sustainability of nutrition services.
4. Create model contracts for community-based organizations and provide guidance to facilitate their entry into Medicaid partnerships and help them meet the necessary administrative requirements.
5. Streamline screening and reimbursement systems. Simplifying these systems is crucial for ensuring that community-based organizations can focus on service delivery rather than administrative burdens.
6. Establish shared goals and metrics, particularly around local food procurement, to measure success in both health outcomes and support for local agriculture.
7. Designate Medicaid managed care organizations to have dedicated staff who can assist community-based organizations and patients with technical support, billing and referrals.

“The release of Hawaiʻi Appleseed’s report comes at a pivotal time, as Hawaiʻi prepares to implement its Section 1115 waiver,” Spoto said. “With a strong focus on integrating nutrition supports into Medicaid and fostering local food systems, Hawaiʻi is poised to lead in both healthcare innovation and sustainable food production. The report’s recommendations provide a roadmap for ensuring that these services are effectively rolled out, benefiting both patients and local communities.”

The report is available for viewing by clicking here.