At least a dozen U.S. states are rolling out medically tailored meals in pilot projects through Medicaid, the federal–state health insurance program serving 71 million Americans who qualify based on income or disability status. Now, the first large statewide analysis of Medicaid data finds that people with diabetes, heart disease, depression, and other conditions who received these home-delivered, dietitian-designed meals experienced significantly fewer health emergencies and lower costs of care than those who did not.
The new study, published today in Nature Medicine by researchers at the Food is Medicine Institute at Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy at Tufts University, UMass Chan Medical School, Community Servings, and multiple state healthcare systems, found that Massachusetts Medicaid members who received medically tailored meals had 31% fewer hospitalizations and 20% fewer emergency department visits. Per-person healthcare costs declined by $3,433 while patients were on the meal program (an average of roughly six months), offsetting 98% of the program’s cost.
“As the first state to broadly offer medically tailored meals in Medicaid to Americans with diet-related diseases, Massachusetts provided an important opportunity to evaluate the real-world impact of such a program,” said senior author Dariush Mozaffarian, cardiologist and director of the Food is Medicine Institute. “Our results show that food really is medicine, with major clinical and policy implications for health-insurance coverage of medically tailored meals to impact diet-related diseases and healthcare costs.”
The researchers analyzed data from 2020 to 2023 across 11 healthcare systems in Massachusetts. They compared outcomes for 1,866 people who received meals with similar eligible Medicaid members who did not, carefully accounting for differences such as demographics, health conditions, and prior healthcare use.
All meals were prepared and delivered by Community Servings, a Boston-based nonprofit. Participants received 10 meals per week—a mix of breakfasts, lunches, and dinners—plus snacks. Each participant had an initial consultation with a registered dietitian nutritionist to tailor meals to their medical needs and dietary preferences.
Study participants received meals for periods of time ranging from three to 33 months, with participants typically receiving meals for about six months.
Using Medicaid claims data, the researchers tracked hospitalizations, emergency visits, primary care visits, and overall costs. They also ran multiple statistical checks to confirm their findings, including analyzing data from before the meal program began to ensure that differences between groups were not already present. The results were consistent across all these approaches.
Medically tailored meals were not only associated with better outcomes but also net cost savings for Medicaid, even accounting for the cost of the meals, for people with certain conditions. These included heart disease, chronic kidney disease, diabetes, and depression—highlighting that the program could not only improve health, but also save the state and federal government money. Reductions in hospitalizations and emergency visits occurred within months while participants were receiving meals, indicating relatively rapid effects. The study also found that Medicaid patients receiving meals for longer had the largest improvements in healthcare costs.
Also, importantly, the program did not reduce necessary care, such as primary care visits.
“These findings show that medically tailored meals can be both clinically effective and economically sustainable within Medicaid,” said first author Kurt Hager, an assistant professor of population and quantitative health sciences at UMass Chan.
The authors noted several limitations. Because participants were not randomly assigned to receive meals, any unmeasured differences between those who chose to receive meals and those who did not could have affected the results. In addition, the study reflects a program delivered by an established nonprofit serving people at higher risk due to health and economic factors; outcomes may differ among other meal providers or among healthier patients or patients with greater economic stability.
States across the country are increasingly testing Medicaid programs that address nutrition, and the Centers for Medicare and Medicaid Services have highlighted the important role of nutrition recently. Findings from Massachusetts could guide similar meal programs across the country.
“It’s rare to find anything in medicine that both improves health and saves money,” said Mozaffarian. “It should be a no-brainer to extend similar programs to patients in other states and covered by other health insurance programs, such as Medicare and employer-based insurance.”
Research reported in this article was supported by the National Institutes of Health’s National Institute of Diabetes and Digestive and Kidney Diseases under award number R01DK134452 and by the Massachusetts Executive Office of Health and Human Services. Complete information on authors, funders, methodology, limitations, and conflicts of interest is available in the published paper. The content is solely the responsibility of the authors and does not necessarily represent the official views of their funders.
