Medicaid: Food is Medicine
Many health issues can be caused or worsened by diet, including diabetes and heart disease. Programs that provide healthy food to help people manage their conditions and avoid medical interventions are part of the Food Is Medicine movement.
Medically tailored meals
A new Food Is Medicine benefit called medically tailored meals (MTMs) is now available for some Medicaid members. These fresh or frozen prepared meals are customized by a registered dietitian to meet your unique health needs. They help you manage a medical condition, meet your nutrition goals, and avoid hospital stays or emergency room visits.
You must have BadgerCare Plus or Supplemental Security Income (SSI) Medicaid and get your benefits from an HMO (health maintenance organization) that has decided to offer MTMs.
If eligible, you can get up to two meals per day for up to 12 weeks (or longer if approved by your HMO) at no cost to you. Your HMO must approve the meals before you get them.
Am I eligible?
To qualify for MTMs, you must also have:
- A high-risk condition during your pregnancy or postpartum
- Diabetes, and were discharged from a hospital in the past 90 days
- Cardiovascular disease, and were discharged from a hospital in the past 90 days
MTMs are not available with fee-for-service coverage. They are also not covered for members with coverage under any other Medicaid programs, such as:
- Care for Kids (C4K)
- Children’s Long-Term Support Services (CLTS)
- Family Care
- Family Care Partnership
- IRIS (Include, Respect, I Self-Direct)
- PACE (Program of All-Inclusive Care for the Elderly)
Participating HMOs
Contact your HMO's member services department to see if they cover MTMs. Go to our BadgerCare Plus: Member Information page for their contact information.
Resources
Learn more about Food Is Medicine:
- Food Is Medicine Coalition
- Food Is Medicine from the U.S. Department of health and Human Services, Office of Disease Prevention and Health Promotion
Get started
If your medical provider (like a doctor, nurse, or physician assistant) thinks medically tailored meals would be right for you, they can make a referral to your HMO. You can also request the service directly from your HMO by calling their member services department. Go to our BadgerCare Plus: Member Information page for their contact information. Then, your HMO reviews your medical history or doctor’s referral to determine if you’re eligible and the service is medically appropriate for you. If you meet criteria, your HMO can approve the service. Your HMO must approve MTMs before you get them.
You do not need a referral from a dietitian. However, once you are approved for this benefit, you have to meet with a dietitian to develop your meal plan. MTMs can only be provided under the supervision of a registered dietitian who is licensed to practice in Wisconsin.
Member questions and answers
The process starts by either working with your HMO directly or getting a referral from your medical provider (doctor, nurse practitioner, or physician assistant, for example). Either the provider or the HMO will decide if MTMs are medically appropriate for your condition. The HMO can determine if you meet the eligibility criteria and approve the service. You’ll then meet with a dietitian who will design your meal plan.
The meals will be already cut, assembled, portioned, and possibly cooked. You should only need to reheat the meal and should not need extensive kitchen equipment or cooking skills. The meals may be delivered or available for pickup, depending on the meal provider. You’ll get more information about the details if you are approved for the benefit.
Your dietitian can help make sure the meals accommodate your allergies, preferences for specific food items, and cultural or religious preferences. At a minimum, we expect all meal providers to accommodate common food restrictions, preferences, and allergies, such as gluten free, vegetarian, dairy free, and/or vegan. We also encourage offering culturally appropriate meals with traditional ingredients.
Possibly. It depends on which meal provider is serving your area. Check with your HMO for details about the meal provider they are working with and the options they offer.
No. Medically tailored meals do not have any impact on your FoodShare or WIC benefits.
Your HMO should have a process for you to appeal their decision. Check with them for details. If you go through their steps but are still not approved, you may be able to request a state fair hearing. Go to the Wisconsin Department of Administration Request a Hearing webpage to learn more.
Your HMO can decide at any time to start offering this benefit. You might check with them to see if they have any plans in the works. They may also have other support available for your condition.
Provider questions and answers
HMOs are not required to offer this service. If you don’t know if the member’s HMO offers this service, contact the member’s HMO. If the HMO offers this service, follow the HMO’s process for submitting a referral. The referral must be approved by the member’s HMO before the member can receive medically tailored meal services.
The member could be hospitalized for another reason and have cardiovascular disease or diabetes and qualify for medically tailored meals.
Cardiovascular disease may include any cardiovascular diagnosis that is based on clinical findings, such as laboratory tests or medical examination. This would be inclusive of a diagnosis of hyperlipidemia or hypertension. If you are unsure if a member’s diagnosis qualifies, contact the member’s HMO. The member’s HMO is responsible for determining if the member meets eligibility criteria.
Members with any type of diabetes who have been discharged from a hospital in the past 90 days may be eligible. If you are unsure if a member’s diagnosis qualifies, contact the member’s HMO. The member’s HMO is responsible for determining if the member meets eligibility criteria.
No. Before getting meals, the member must meet with a registered dietitian that is employed by or contracted with the meal provider and who has access to meal nutrition information. This dietitian will verify that the meal plan meets the member’s needs. Because registered dietitians are not Medicaid-enrolled providers, the meal provider must bill for these services on behalf of the dietitian.