CW: Food Insecurity
They are touted as healthful, “dietitian-approved” meals. The meals are delivered to the homes of older and disabled people, who often have conditions such as cancer, diabetes, and heart disease. The offerings include Jimmy Dean frozen sausage breakfast sandwiches, biscuits and gravy, and cheeseburgers.
These are some of the foods provided by Homestyle Direct. Homestyle Direct is an Idaho-based company that receives millions of dollars annually from taxpayer-funded state Medicaid programs to distribute what it calls medically prepared meals. The company, which claims to provide 7.8 million meals every year, provides menus for people with cancer and diabetes, as well as “heart healthy” and “renal friendly” selections.
However, several nutrition experts told STAT that many of Homestyle Direct’s offerings fall far short of what they consider medically tailored meals, Medically tailored meals have been shown to assist people with diet-related illnesses improve their health and stay out of the hospital. Most don’t appear to meet the new optional accreditation standards developed by medically- tailored food providers.
“Homestyle Direct to me doesn’t look like medically tailored meals at all — it doesn’t even look like generally healthy meals,” said Dariush Mozaffarian, director of the Food is Medicine Institute at Tufts University.
The company’s ability to bill Medicaid for meals high in sodium and saturated fat — some of which could be purchased at a lower cost in a grocery store — raises concerns about federal and state oversight of meal delivery programs. Home delivered meal services are available to people who have trouble leaving their homes. Home delivered meals are also an available option under many HCBS waivers.
Older people often have trouble accessing nutritious foods. A survey done last year by The Greater Chicago Food Depository found that wait times, mobility, and transportation were identified as the top three barriers to accessing local food pantries.
Additionally, according to a study done by Boston University, older adults who have three or more functional limitations are nearly twice as likely as those who don’t to report both income-driven food insecurity (10.4 vs. 4.6%) and logistics-driven food insecurity (21.2 vs. 11.2%).
Disabled people also struggle with food insecurity. Food insecurity is more likely to occur in households with disabled members. Food insecurity affects families with an adult who receives federal or state disability benefits 22% of the time.
In comparison, food insecurity affects households with an adult with a disability who does not receive benefits 33% of the time. Households without an adult who is disabled only experience food insecurity in 8% of cases. Therefore, home delivered meals can be a lifeline for lots of people.
While there is no standard definition of a medically-tailored meal, most nutrition experts agree that it should be low in salt, added sugar, and saturated fat and rich in other nutrients such as fiber. Many people also want these meals to be free of additives like preservatives and stabilizers, which are commonly found in processed foods.
For example, the cheeseburger contains more than 50 different ingredients. The cheeseburger is advertised as being recommended for patients with cancer, heart disease, and diabetes. However, consumption of ultra-processed foods is linked to these same conditions.
Homestyle Direct is one of several for-profit organizations that bill Medicaid for home-delivered meals. Magic Kitchen sells its own biscuits and gravy, which has 1,110 mg of sodium and 12 grams of saturated fat. The American Heart Association recommends that people limit their sodium intake to less than 2,300 mg per day, which is about equivalent to one teaspoon of table salt.
Homestyle Direct’s CEO, Jeff Barteau, stated that the company observes state standards governing the nutritional content of meals and seeks “to balance nutritional guidelines with palatability and cultural preferences.” “Our goal is to make medically tailored meals more widely available, especially to those living in food deserts or rural communities,” according to his statement. “It’s important to note that there are currently no universal standards for medically tailored meals or specific standards for each disease category.”
States establish their own standards for Medicaid meal programs. They frequently set loose rules regarding the nutritional content of the food. STAT merely requested that the meals delivered to patients have at least one-third of the nutrients that a person is intended to consume in a day, known as the Dietary Reference Intake.
The poor Medicaid nutritional quality guidelines are most likely a result of how the program that pays for these meals was designed. Rachel Landauer, a clinical instructor at Harvard Law School’s Center for Health Law and Policy Innovation says that the meals weren’t originally developed with nutrition in mind. Instead, they were developed for people who had trouble leaving their homes.
Advocates fear that companies like Homestyle Direct are aiming to capitalize on the expanding Food is Medicine movement. The Food is Medicine movement seeks to better integrate healthy food with traditional healthcare.
Since the 1980s, nonprofit, community-based organizations have been the primary providers of medically tailored meals. Back then, medically-tailored meals were typically provided to AIDS patients. That has begun to change, however, as Food is Medicine has gained traction in Washington. The movement has garnered support from the Biden White House and national organizations such as the American Heart Association and the Rockefeller Foundation.
Nutritious foods should be easily accessible and affordable. People should not be forced to eat specific meals simply because they can’t leave their homes. A balanced diet can help manage health conditions. Medically-tailored meals are a wonderful concept, but they should be healthy.
Sources:
Brucker, Debra L, and Derek Nord. “Food Insecurity Among Young Adults With Intellectual and Developmental Disabilities in the United States: Evidence From the National Health Interview Survey.” American journal on intellectual and developmental disabilities vol. 121,6 (2016): 520-532. doi:10.1352/1944-7558-121.6.520
Choi, Shinae L., et al. ‘Physical Disability and Older Adults’ Perceived Food and Economic Insecurity During the COVID-19 Pandemic’. The Journals of Gerontology: Series B, vol. 77, no. 7, July 2022, pp. e123–e133, https://doi.org10.1093/geronb/gbab162
Cahill, Rachel M., and Laura J. Samuel. “Food Insecurity in the Disability Community: Disparities in Snap Access: .” Health Affairs, Health Affairs , 17 May 2021, https://www.healthaffairs.org/do/10.1377/forefront.20210513.420153/.
Florko, Nicholas. “Medicaid Is Paying Millions for Salty, Fat-Laden ‘medically Tailored’ Cheeseburgers and Sandwiches.” STAT, Boston Globe Media, 12 July 2024, http://www.statnews.com/2024/07/11/medicaid-food-is-medicine-medically-tailored-meals-quality-questioned/.
First, Devra. “They Fed Patients in the Early Days of AIDS. Their Work Continues to Shape Health Care Today. .” The Boston Globe, Boston Globe Media , 27 June 2024, http://www.bostonglobe.com/2024/06/26/lifestyle/they-fed-patients-early-days-aids-their-work-continues-shape-health-care-today/.
Hernandez, Francia Garcia. “Food Delivery Service for People with Disabilities Extended.” Austin Weekly News, Growing Community Media, 12 Sept. 2023, http://www.austinweeklynews.com/2023/09/12/food-delivery-service-for-people-with-disabilities-extended/.
Lane, Melissa M., et al. ‘Ultra-Processed Food Exposure and Adverse Health Outcomes: Umbrella Review of Epidemiological Meta-Analyses’. BMJ, vol. 384, Feb. 2024, p. e077310, https://doi.org/10.1136/bmj-2023-077310.
Perlman, Jenna. “Medicaid-Funded Meal Service Ships Unhealthy Food to Patients.” The Boston Globe, Boston Globe Media , 14 Aug. 2024, http://www.bostonglobe.com/2024/08/14/metro/medicaid-spends-millions-salty-fat-filled-medically-tailored-meals/.
Shen, Chen, et al. ‘How Much Sodium Should We Eat?’ Progress in Preventive Medicine, vol. 5, no. 1, LWW, 2020, p. e0026.