Over the past two weeks, there has been a flurry of activity from the Centers for Medicare & Medicaid Services (CMS) that affects health-related social needs (HRSN) and Food is Medicine (FIM) services in Medicare and Medicaid:
Medicare Parts C & D Contract Year 2026 Notice of Proposed Rulemaking: On November 26, 2024, CMS announced a proposed rule for Medicare Parts C and D that lays out several noteworthy proposals for plan contract year 2026 and which have the potential to impact Food is Medicine in Medicare Advantage and Medicaid. Most noteworthy is a proposal to establish Medicare and Medicaid coverage for GLP-1s for obesity (which could create an opening to explore the impact of pairing such medications with FIM services for longer-term health changes). Public comments are due on January 27, 2025. CHLPI summarizes key features here.
Updated HRSN Medicaid and CHIP Coverage Guidance: On December 10, 2024, CMS released an updated Center Informational Bulletin and HRSN Framework that “clarifies, updates, and supersedes” the guidance the agency released in November 2023. The updated guidance largely reiterates and strengthens the legal language supporting Medicaid and CHIP coverage of HRSN services. However, some notable updates may have practical implications for programs on the ground (e.g., the requirement that Medicaid programs use the USDA definitions of low and very low food insecurity when establishing eligibility for FIM services). CHLPI’s overview of the updated guidance, including notable policy clarifications/changes from November 2023 is available here.
New State Medicaid 1115 Proposals and Approvals: On December 10, 2024, CMS approved a five-year extension of the North Carolina Medicaid Reform Demonstration. The extension includes authority to expand the Healthy Opportunity Pilots (HOP) to provide HRSN services, statewide, in line with the Special Terms & Conditions and CMS’s updated HRSN Framework released on December 10, 2024. CMS is “still reviewing” several of the state’s requests, including HOP services for firearm safety education and device distribution, childcare subsidy co-pay support, mortgage assistance, lead abatement, transportation beyond that permitted in CMS’s updated HRSN Framework, and diapers. There are currently 10 states with approved (CA, DE, IL, MA, NC, NJ, NM, NY, OR, WA) and 6 with pending (CO, DC, HI, NV, PA, RI) 1115 Medicaid demonstration waivers that include coverage for the direct provision of food.
These developments, many of which are still in proposal form and will not be finalized this year, thrust us with momentum into 2025 and a new federal policy landscape.