| Lauren Driscoll and Robert Blancato

---

| As the nation marks Older Americans Month, one gap in Medicare’s architecture deserves urgent attention from Congress and federal health administrators alike: the absence of clinically guided, food-based interventions as a reimbursable tool in the treatment of diet-related disease.

This is not a fringe idea. A bipartisan group of 46 lawmakers led by Representatives Jim McGovern and Vern Buchanan sent a letter to congressional appropriators on March 26 urging robust funding for Food Is Medicine initiatives in FY2027. With appropriations decisions now taking shape, that letter signals growing cross-aisle support for programs across federal agencies. This is an opportunity to improve outcomes and meaningfully reduce costs.

At the same time, CMS is launching a new generation of innovation models — Rural Health Transformation, ACCESS, and MAHA ELEVATE — aimed at moving healthcare from reactive sick care toward prevention. Yet these models largely omit one of the most practical tools for that vision: clinically guided, food-based interventions. Pairing congressional support with CMS model design could unlock far greater impact.

In a food environment dominated by ultra-processed options and aggressive marketing of low-nutrient products, sustained dietary change is difficult to achieve through willpower or counseling alone. For many living with diet-related disease, these conditions reflect years — often decades — of entrenched dietary patterns. 

Support independent journalism on aging

A structured clinical food intervention offers something different: guided exposure. Patients experience appropriate portions and condition-specific diets in real time, paired with behavior-change support like goal setting and repeated practice. Distinct from food assistance this time-limited, clinically targeted intervention builds durable skills, much like physical therapy or diabetes self-management training.

Medicare serves older adults and individuals with disabilities who carry the highest burden of diet-related disease, yet it lacks a mechanism to deliver food as part of care. Programs like the Older Americans Act recognize the importance of nutrition intervention, serving a vital role in community health and prevention. However, these programs are structurally distinct from the clinically targeted interventions Medicare needs to integrate into medical care. Meanwhile, physicians in value-based arrangements are increasingly accountable for outcomes like HbA1c and blood pressure — metrics heavily influenced by diet — yet they lack a reimbursable tool to help patients change the dietary behaviors driving those conditions.

One place to begin is with populations where the clinical pathway and cost implications are especially clear. Congestive heart failure remains the leading driver of hospital admissions among Medicare beneficiaries, with many admissions tied to challenges like sodium management and dietary adherence. Analyses of medically tailored meal interventions suggest that patients with heart failure experience some of the largest reductions in hospitalizations on a per-patient basis — reflecting the intensity of their baseline risk and the outsized opportunity to prevent avoidable admissions through targeted dietary intervention.

Federal healthcare already incorporates food as clinical care in specific contexts. HRSA’s Ryan White HIV/AIDS Program allows providers to deliver medically tailored meals and groceries as part of comprehensive HIV care. And HRSA recently announced $125 million for Expanded Nutrition Services across roughly 350 health centers and $15 million for medically tailored meals for high-risk maternal populations. When nutrition is integral to managing disease, it can be delivered as care — not treated solely as social intervention.

By statute, Medicare covers services that “diagnose or treat illness or injury.” Structured, time-limited food intervention could reasonably fit within treating diet-related disease. Even if the statute is read narrowly,  The Center for Medicare and Medicaid Innovation (CMMI) has clear authority to test and pay for approaches traditional Medicare does not yet cover.

Food-based interventions consistently demonstrate improvements in glycemic control, weight, blood pressure, and cardiometabolic risk. 

• A recent meta-analysis found that medically tailored meal programs were associated with 19.7% lower healthcare expenditures and 47% fewer hospitalizations annually. 
• In Massachusetts Medicaid, Food is Medicine participation was associated with a 23% reduction in hospitalizations and a 13% reduction in emergency department visits. 
• A national simulation model estimated that medically tailored meals for U.S. adults with diet-sensitive conditions could generate $38.7 billion in healthcare savings — yielding net savings of $13.6 billion annually.

Federal activity is expanding, but unevenly. In Medicare Advantage, roughly 60% of plans now offer meals or food as supplemental benefits. But original Medicare — where the burden of diet-related disease is greatest — has not incorporated these interventions into its core models.

The bipartisan Accountable Produce is Medicine Act, recently introduced by Representatives Lloyd Smucker and Sharice Davids, would direct CMMI to test a bundled payment model integrating produce prescriptions across Medicare, Medicaid, and other federal health programs. That is a step in the right direction — and a clear signal that Congress is ready to act.

Concerns about cost and program integrity are valid. Programs must be carefully designed to be targeted, time-limited, clinically supervised, and outcomes-driven. Registered dietitians ensure interventions are personalized and accountable. This is not a broad entitlement — it is a focused clinical tool that could yield considerable savings.

Congress has signaled support. CMS has built the models to transform care delivery. The opportunity now is alignment: integrating clinically guided dietary interventions into CMMI models — starting with clearly defined, high-risk use cases — would equip clinicians with tools that match their accountability and deliver value to the Medicare beneficiaries who need it most. The question is not whether food can be medicine. The evidence has answered that. The question is whether federal health policy will catch up.

Lauren Driscoll is the Founder and CEO of NourishedRx, a scalable, data-enabled Food Is Health platform that puts nutrition at the center of care, connecting food, healthcare, and social support to deliver measurable health impact. 

Bob Blancato is Executive Director, National Association of Nutrition and Aging Services Programs. As a volunteer, he currently serves on the National Board of AARP and the board of the National Hispanic Council on Aging.