By the Food Research & Action Center
The Food Research & Action Center (FRAC) is a nonprofit that improves the nutrition, health, and well-being of people struggling against poverty-related hunger in the United States through advocacy and partnerships, and by advancing bold and equitable policy solutions.
Healthcare practitioners don’t often equate endoscopy with social services. However, any medical professional— particularly those in gastroenterology—has unique access to information about whether a person is receiving proper nutrition. Does your office screen for food insecurity in your patients? If not, it may be a good idea to start.
Across the United States, healthcare providers are now screening millions of patients for food insecurity, spurred in part by several large-scale national quality and standards-setting initiatives requiring screenings for health-related social needs (HRSN), including food insecurity. For example, given new Centers for Medicare & Medicaid Services (CMS) requirements, hospitals will be required to screen patients for food insecurity and refer patients to appropriate resources to improve patient well-being and prevent readmission related to a social determinant of health.
Many healthcare providers are addressing food insecurity by connecting patients to the Supplemental Nutrition Assistance Program (SNAP), Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), school meals, and other federal nutrition programs, which are enormously well-studied, with documented benefits to health, nutrition and well-being. This should serve as the foundational intervention to address food insecurity.
Referring Patients
The primary intervention for healthcare systems to address health-related food insecurity and improve patient nutrition and health should be ensuring eligible patients are accessing the federal nutrition programs. These include SNAP, WIC, after-school and summer meal programs, childcare meals, school breakfast and lunch, and congregate and home-delivered meals for older adults.
These federal nutrition programs are available nationwide, come with billions of dollars in federal funding, and have reams of research attesting to their efficacy in improving nutrition, health, and well-being of participants. Connecting patients to federal nutrition programs such as SNAP and WIC would also result in an overall decrease in healthcare costs and readmissions and provide patients with a better quality of life.
Using healthcare settings to connect patients to SNAP and WIC has become a national priority. The efficacy of these efforts is highlighted in the American Academy of Pediatrics’ 2015 “Promoting Food Security for All Children” policy statement (reaffirmed in 2021) that extols the importance of connecting children and their families to SNAP, WIC, school meals and other federal nutrition programs.
Additionally, the 2022 White House National Strategy on Hunger, Nutrition, and Health encourages the healthcare sector to “screen for food insecurity and connect people to the services they need,” including SNAP and WIC. In November 2023, the White House released the first ever U.S. Playbook to Address Social Determinants of Health, which underscores the importance of SNAP and WIC in improving food security and includes commitments from CMS and the U.S. Department of Agriculture (USDA) to use data to bolster enrollment of Medicaid participants in food assistance programs, such as WIC, SNAP, and free and reduced-price school meals.
WIC is the ultimate fruit-and-veggie prescription program. The WIC food package makes permanent increases for fresh and vegetables benefits for millions of eligible WIC participants across the country. Children’s benefits for fruits and vegetables are $25 per month (up from $9) and pregnant and postpartum participants rise to $44–$49 per month (up from $12).
Federal Nutrition Programs Improve Health Outcomes
An ever-growing body of research underscores how participation in these federal nutrition programs is a winning strategy to improve nutrition and health.
As the largest federal nutrition program, SNAP has a profound impact on population-level economic, nutrition and health outcomes— particularly when its benefit levels are adequate for purchasing healthy foods. Enrollment in SNAP is linked to improved health outcomes, better medication adherence, and lower risk of heart disease and obesity. In addition, SNAP is linked to better access to preventive healthcare and reduced healthcare. Findings from a study of more than 60,000 older adults with low incomes show that one year after participants start receiving SNAP, they are 23% less likely to enter a nursing home and 4% less likely to be hospitalized.
WIC was established in 1972 as a medically tailored public nutrition intervention for at-risk mothers and children. WIC is the original “Food Is Medicine” program, proven to prevent obesity and improve food security, dietary intake, birth and health outcomes, and economic stability. The longer children participate in WIC, the healthier their diets. Extensive research suggests that WIC contributes to better birth outcomes and healthier babies. In fact, a study conducted in 2019 by Nianogo, et al., showed that participation in WIC resulted in cost savings, including both savings pertaining to WIC intervention costs as well as savings due to tangible and intangible costs associated with pre-term birth.
School Meals
The National School Lunch Program—the nation’s second largest food and nutrition assistance program—makes it possible for school children in the U.S. to receive a nutritious lunch every school day. Millions of children also benefit from school breakfast each day. Children of families at low or moderate income levels can qualify for free or reduced-price school meals.
Meals must meet federal nutrition standards, which currently require schools to serve more whole grains, fruits and vegetables. Participation in school meals has favorable impacts on a number of outcomes, including food security, dietary intake, obesity and health status. Research has demonstrated that school meals are the healthiest meals that many school- children eat during the day. Research shows that students who participate in the school meals programs consume more whole grains, milk, fruits and vegetables during mealtimes and have better overall diet quality than nonparticipants.
Steps Healthcare Providers Can Take
Healthcare providers, bolstered by anti-hunger collaborators, can ensure patients are accessing SNAP, WIC and other federal nutrition programs by utilizing a range of strategies and resources, such as FRAC’s online course, “Screen & Intervene: Addressing Food Insecurity Among Older Adults.” Healthcare providers use various approaches to connect patients to SNAP and WIC, including two types of food referrals.
Passive referrals: Healthcare providers give patients information about food resources, including information on SNAP, WIC, other federal nutrition programs, and additional resources such as food pantries. In some cases, handouts may include more detailed—and often localized—information on how to access SNAP or WIC from pertinent agencies. Healthcare providers may also use texting to promote opportunities to connect patients to SNAP and WIC.
Active referrals: Healthcare providers connect patients with programs either through on-site assistance or through referral partnerships. Through on-site assistance, patients are referred to full- or part-time on-site case managers, patient navigators, community health workers, resource coordinators or social workers, who assist them in applying for SNAP or WIC. Through referral partnerships, healthcare providers can collaborate with state or local community-based orga- nizations or agencies. Examples include creating a process by which patients who are interested in being connected to SNAP and WIC consent to a partner organization reaching out to them; hosting a partner organization or agency at the health provider site who provides patients with assistance applying for SNAP or WIC; and/or developing a formal Memorandum of Understanding (MOU) with partners to provide SNAP and WIC application assistance.
Healthcare providers can leverage the growing efforts around the Office of Disease Prevention and Health Promotion’s Food Is Medicine program as one opportunity to connect patients to the federal nutrition programs. The Department of Health and Human Services considers Food Is Medicine to include “approaches that focus on integrating consistent access to diet- and nutrition-related resources” as a critical component. Connecting patients to the federal nutrition programs fits within this approach and constitutes an important primary intervention.
Section 1115 waivers should be considered. Section 1115 waivers (sometimes known as Section 1115 demonstrations), allow states to experiment with new approaches to Medicaid and to tailor portions of it, such as by testing new services. As states continue to be approved for Section 1115 waivers for medically tailored meals, groceries, and other nutrition interventions, these services should supplement, not supplant, existing federal, state and local nutrition supports. State Medicaid agencies should partner with other state agencies and social service providers to ensure that beneficiaries experiencing food insecurity are connected to programs like SNAP and WIC. Medicaid also needs to explain how it will track and improve upon enrollment in SNAP and WIC.
Research continues to grow and evolve on the healthcare sector’s increased awareness of patients’ health-related social needs—including food insecurity—and its efficacy addressing these needs. Yet, while many healthcare providers are connecting patients to SNAP and WIC, the published literature that looks at healthcare providers connecting patients to SNAP and WIC is limited.
Future Study Recommendations
Too few of the published studies provide needed insights as to how healthcare providers are creating sustainable systems to connect patients to SNAP and WIC. Given the vital role of these programs to patient health, it is important to understand how healthcare organizations can sustainably provide screening and active referrals (whether on-site or provided by another organization).
Future research is needed to improve the efficiency and cost-effectiveness of active referral systems, as well as ways to continue moving toward broader systems improvements such as seamlessly connecting people to Medicaid, SNAP and WIC through fully integrated applications.
Additionally, we still have significant limitations in understanding the full scope of patients who may be at risk of food insecurity, as well as those who could benefit from referrals to food assistance programs. Many studies highlight the stigma and social vulnerability associated with sharing food insecurity and other social needs with healthcare providers. Studies also suggest that families may underreport social problems. In addition, the screened population may not be representative of the overall population because universal screening is not always implemented in healthcare. More qualitative surveys would be beneficial to understand families and their experience with food insecurity and how best to connect them with supplemental resources.
More research is needed to assess individual knowledge, attitudes and beliefs around screening for food insecurity and around SNAP and other food benefit programs. Specifically for WIC, research is needed on effective strategies to improve the retention of children older than 1 year. Future work should focus on understanding how to increase the rate at which those who are reporting food insecurity are being linked to resources.
A significant body of evidence suggests that enrollment in SNAP and WIC improves health, helps manage chronic disease, and reduces health cost and utilization. Likewise, children’s participation in school meals favorably impacts food security, dietary intake, obesity level and health status. As screening for food insecurity continues to proliferate, it is imperative that healthcare providers are educated on the importance of SNAP, WIC and other federal nutrition programs as primary interventions to improve health outcomes and on which methods to connect patients to these programs are most effective.
Healthcare providers can play a key role in closing participation gaps in access to nutrition programs. Planning is needed to determine whether healthcare providers have capacity for a passive referral or an active navigation model, with the goal of eventually establishing a sustainable, effective process that is integrated with their electronic health system. Future research should build out evidence-based best practices that healthcare providers can tailor to their circumstances and integrate in their standard practice for screening and intervening.
Building sustainable healthcare systems to ensure every eligible patient is connected to SNAP, WIC, school meals and other federal nutrition programs is a winning intervention to address food insecurity and improve health.
The Food Research & Action Center improves the nutrition, health, and well-being of people struggling against poverty-related hunger in the United States through advocacy and partnerships, and by advancing bold and equitable policy solutions. For more information about FRAC, or to sign up for FRAC’s e-newsletters, visit www.frac.org. For research citation, visit https://bit.ly/40mjMLs.
