As Washington Pulls Back on Medi-Cal, Sacramento Can Push Forward on Health Equity with Food as Medicine
The Food as Medicine Collaborative hosts a food pharmacy at Castro-Mission Food Health Center in San Francisco, California, in June 2023. Photo courtesy of SPUR.
California’s Medi-Cal program — known federally as Medicaid, the health insurance for low-income individuals — is in the midst of a tug-of-war between two opposing forces: federal cost-cutting efforts and state-level investments in healthcare innovation. While federal Republican leaders push to dilute the Medi-Cal program through sweeping cuts, California’s investments in expanding healthcare benefits and piloting new approaches to care have shown results. Despite federal threats casting a cloud on Medi-Cal’s future, California can continue to shine a light on Medi-Cal as a national model for advancing equitable care and improving health outcomes.
If passed, the Republican-led bill that proposes billions in Medicaid budget cuts would restrict access to essential medical services for the approximately 15 million Californians who are enrolled in Medi-Cal, leaving these individuals with fewer resources to manage their health. Adding to this uncertainty, in March, the Centers for Medicaid and Medicare Services rescinded Biden-era guidance which encouraged the use of Medicaid flexibilities to address social drivers of health, including access to housing, food, and transportation. These rollbacks, set to impact about one third of California’s population, would be a devastating blow for families across the state who rely on Medi-Cal.
However, California has long been regarded as a national leader in progressive policymaking and has the potential to set a powerful precedent for the rest of the country to follow. By forging ahead with key Medi-Cal improvements geared at advancing health equity, California can not only safeguard the health of millions across the state, but also send a clear message that we should be strengthening the safety net, not dismantling it.
CalAIM, shorthand for California Advancing and Innovating Medi-Cal, is a key reform that is designed to improve health outcomes by transforming the healthcare system to better meet patients’ complex needs. CalAIM is authorized through a 5-year waiver, which grants California flexibility to test new ways to deliver healthcare services. Embedded within CalAIM, which began in 2022, are fifteen different services known as Community Supports. These community-based services, aimed at advancing health equity and reducing healthcare costs, have allowed patients to receive services not otherwise available through traditional healthcare.
One of these Community Supports is Medically Supportive Food & Nutrition (MSF&N), also known as “food as medicine,” which refers to a spectrum of food-based interventions used to prevent, reverse and treat diet-related health conditions. The spectrum of services includes:
medically tailored meals
medically supportive meals
food pharmacies
medically tailored groceries
medically supportive groceries
produce prescriptions
nutrition education, when paired with one of the aforementioned food services
MSF&N services differ in intensity, from those tailored to address specific health conditions (medically tailored) to those that provide more general nutrition support for the patient’s diet (medically supportive).
These interventions are available across all 58 California counties, with 23 out of 24 managed care plans opting to offer MSF&N services to their Medi-Cal members. Furthermore, over the three-and-a-half years since the inception of CalAIM, over 220,000 patients have accessed MSF&N services, making them the number one most utilized Community Support.
In 2024, building on the evidence of CalAIM’s successful implementation, Assemblymember Mia Bonta introduced AB 1975, a bill that would have both launched a MSF&N Advisory Workgroup and converted MSF&N interventions from temporary, waiver-based services to permanent Medi-Cal benefits. Alongside the Food as Medicine Collaborative, Fullwell led a diverse coalition of over 120 organizations whose collective advocacy helped the bill gain traction and successfully navigate its way through both the Assembly and Senate. Unfortunately, Governor Newsom vetoed the bill in September, slowing down this burgeoning momentum.
Despite this hurdle, we remain committed to advancing the long-term sustainability of MSF&N in healthcare. In recognition of this year’s challenging budget outlook, we pivoted our advocacy strategy. Rather than combining the request for the MSF&N Advisory Workgroup and the transition of MSF&N services to permanent benefits into a single bill, we have separated these into two distinct requests. This year, we are focused on securing funding for the formation of the Medically Supportive Food & Nutrition Advisory Workgroup, which would convene MSF&N experts to support the Department of Health Care Services in developing community-informed guidance that will help to smoothly transition MSF&N interventions from pilot services to full Medi-Cal benefits. The complexity and scale of a permanent benefit will necessitate more detailed implementation guidance and the workgroup would play a critical role in helping create rules around key elements such as dosage, eligibility, and rate setting that would support the successful implementation of MSF&N services.
Assemblymember Mia Bonta is once again championing this proposal and is joined this year by Senator Susan Rubio in co-leading the $75,000 budget request. Although a relatively small budget appropriation, this investment has potential for large impact. The guidance developed by the workgroup will have long-term implications for the future of MSF&N in healthcare and will help ensure that MSF&N services are implemented in a way that advances health equity and meets both patient and provider needs. Securing funding for the workgroup in the 2025-26 state budget would enable it to launch and operate for an entire year before the conclusion of CalAIM, which is set to expire at the end of 2026. While our advocacy this year focused on establishing the workgroup, we recognize that this small step is critical for positioning us to take bolder action in the future, namely securing MSF&N services as permanent, fully covered Medi-Cal benefits.
Despite proposed cuts to Medi-Cal at the federal level, we can still make progress at the state level. We are guided by the evidence — MSF&N services improve health outcomes, reduce healthcare costs, and are backed by a diverse coalition of supporters. Even in the face of challenging odds, California can take a stand in showing the rest of the nation that protecting essential healthcare services is both necessary and effective. Looking ahead, we will continue to advocate for the permanent integration of Medically Supportive Food & Nutrition in healthcare so that all Californians have access to the nutritious foods they need to thrive.