There is consensus among the state’s medical professionals that for patients with specific health conditions, improved nutrition leads to better health outcomes. There is also a recognition many of those patients do not always have the means or ability to access the foods recommended by their doctors.
“For critically and chronically ill people, food is medicine,” state Rep. Michele Meyer (D-Eliot) testified before the Legislature’s Health and Human Services Committee on Monday.
“Efforts to expand programs that provide healthy, nutrient-dense meals and food to Medicaid patients have been hampered by cost-related concerns and short-sighted opposition to providing free or discounted food under a program authorized primarily to provide medical care for low-income individuals,” said Meyer.
The freshman legislator has introduced a bill, LD 1373, that aims to reduce downstream health care costs for the state’s MaineCare enrollees by increasing funding for upstream, nutrition-focused interventions.
Under Meyer’s proposal, doctors would determine those MaineCare patients with health conditions that would be served by targeted nutrition interventions, and then develop specific dietary plans with licensed dietitians.
Managing health conditions like diabetes and high blood pressure depend significantly on consistent meal planning that takes into account calories, sugar and sodium, as well as vitamins and minerals. Other conditions, such as inflammatory bowel disease or celiac disease, may require much more restrictive diets such as formula.
Meyer’s proposal would also give MaineCare enrollees access to assistance with meal preparation and delivery.
That assistance, she said, would help “the chronically ill homebound patient who may be unable to prepare nutritious foods and is at high risk for hospital admission or readmission.” Meyer noted that these early interventions can prevent people from prematurely moving into assisted living or other levels of care — which come at a greater expense.
This could be all be done, Meyer said, by the state’s health department obtaining a waiver from the U.S. Department of Health and Human Services and Centers for Medicare and Medicaid Services to reimburse the state’s MaineCare program.
Those federal agencies could grant the state such a waiver if they determine the costs of preventative, nutrition-focused interventions would not exceed the costs of regular medical care that have no preventative aspects and may result in additional services and procedures.
Study shows program could work in Maine
Meyer points to a privately-funded study by Maine Medical Center and the Southern Maine Area Agency on Aging of the their meal service, Simply Delivered for ME, which they formed to reduce hospital readmission rates. The study found a 387-percent return on investment by providing seven meals to 1,745 people after a hospital visit, saving over $200,000.
“This demonstration project will be both data-centric and data-driven,” Meyer said, explaining that the bill requires that reports go the the state Department of Health and Human Services comparing hospital readmission rates between those receiving medically tailored nutritional interventions and those who do not.
Both MaineHealth and Northern Light Health have endorsed Meyer’s legislation.
“MaineCare families often tell our gastroenterology providers that they struggle to afford medical foods and formula, which results in poor adherence, worsened health status, and, likely, increased utilization from additional visits, tests, and admissions,” said Sarah Calder, director of government affairs for MaineHealth. “Coverage of medical foods has the potential to improve outcomes, and, in some cases, may serve as a viable alternative to pharmacologic therapy.”
Massachusetts, Oregon and Maryland have already obtained waivers allowing their Medicaid enrollees who need special services to obtain home-delivered meals.