Nutrition Therapy Face Uncertain Future as Medicaid Cuts Loom

Volunteers at Community Servings in Boston are preparing specialized meals for Medicaid recipients who cannot shop for groceries or cook for themselves due to chronic illness. For patients like Vanessa Georges, a throat cancer survivor, these deliveries have been life-changing, helping her rebuild muscle mass and confidence while reducing her need for medical appointments.

Georges’ experience is supported by data. A study published in Nature Medicine found that approximately 1,900 Massachusetts residents who received medically tailored meals for at least three months had 20% fewer emergency department visits and 31% fewer hospitalizations compared to similar patients who did not receive the service.

“It actually saves the healthcare system money,” said Dariush Mozaffarian, a cardiologist and Tufts University professor who led the research. “That’s a really big deal, because most things in healthcare don’t.”

Despite the evidence, these programs face significant threats. The 2025 One Big Beautiful Bill Act reduced projected Medicaid funding by over $900 billion. Republican lawmakers, including Sen. John Kennedy of Louisiana, have criticized certain states for what they view as fraud in using Medicaid funds for housing and nutrition. Amaya Diana, a policy analyst at KFF, noted that states will face difficult choices filling funding gaps, potentially leading to program cuts.

Currently, thirteen states have federal waivers allowing Medicaid dollars to pay for meals under the “food is medicine” framework, with three other programs awaiting approval. While the first Trump administration permitted such initiatives, the current administration has rescinded Biden-era guidance on social needs in Medicaid. Officials have signaled a more skeptical approach, focusing heavily on budget impacts rather than broad-based national policy.

Kurt Hager of UMass Chan Medical School observed that the administration is likely to make decisions on a state-by-state basis. Meanwhile, HHS Secretary Robert F. Kennedy Jr. and CMS Administrator Mehmet Oz have emphasized nutrition, urging hospitals to serve healthier foods. Oz has criticized the system for paying for surgeries but not for the nutrition that could prevent the need for them in the first place.

Critics of the programs point to instances where companies billed Medicaid for unhealthy meals, raising concerns about regulation. However, providers like Community Servings work closely with healthcare teams to prescribe diets based on diagnoses, medications, allergies, and cultural norms.

The Massachusetts study indicated that the meals, costing $125 per person weekly, essentially paid for themselves. Patients with heart disease saved about $10,000 in healthcare services over six months, while those with kidney disease saved $12,000. Mozaffarian estimates that medically tailored meals could prevent 1.6 million hospitalizations nationally and save $13.6 billion in healthcare costs annually, yet only a small fraction of the estimated 10 million eligible Americans are currently enrolled.

For recipients like Steve Honyotski, a 71-year-old with diabetes and obesity, the meals have allowed him to reduce insulin usage and lose enough weight to delay knee replacement surgery. Massachusetts Medicaid director Ryan Schwarz stated the state is committed to continuing the service and will seek federal approval. In contrast, North Carolina lawmakers suspended similar food and housing supports in 2025 due to budget concerns.