National and State Policy Decisions Addressing Food Insecurity During COVID-19

The U.S. Department of Agriculture reports that 37 million people, including 6 million children, were living in food-insecure households in 2018.¹ Since the start of the COVID-19 pandemic, an estimated additional 17 million people will face food insecurity in 2020 — raising the total to a staggering 54 million Americans.²

What is being done at the national and state levels to address food insecurity and nutrition as COVID-19 continues to spread? Take a look...

National response

As of June 2020, Congress passed several bills designed to mitigate the social, health and economic effects of COVID-19. Altogether, these comprise more than $6 trillion in appropriations — with nearly $1 trillion directly related to nutrition programs, such as WIC, TEFAP and SNAP.³
The Nutrition Services Program, authorized under Title III of the Older Americans Act (OAA), received a total of $720 million in FY2020 supplemental funding for nutrition programs to respond to the COVID-19 pandemic. OAA’s largest program, the Nutrition Services Program is designed to address problems of food insecurity, promote socialization, and promote the health and well-being of older persons through nutrition and nutrition-related services. It provides grants to state agencies on aging to support congregate and home-delivered meals for people aged 60 and older.⁴
The Centers for Medicare & Medicaid Services (CMS) announced changes allowing Medicare Advantage plans greater flexibility for nutrition benefits. CMS is temporarily relaxing enforcement of a 2008 rule prohibiting mid-year benefit enhancements for Medicare Advantage organizations (73 Federal Register 43628), as long as the new enhancements are:
- Provided in connection with the COVID-19 outbreak
- Beneficial to enrollees
- Provided uniformly to all similarly situated enrollees

Many Medicare Advantage plans now offer additional telehealth benefits and expanded
benefits, like meal delivery or medical transport services.⁵

On March 13, 2020, pursuant to section 1135(b) of the Social Security Act, the Department of Health and Human Services (HHS) invoked its authority to waive or modify certain requirements of title XVIII, XIX and XXI of the Act. The section 1135 waivers give Medicaid health plans the flexibility to offer certain benefits, including home-delivered meals, to members even if the plans had not filed for the benefit, or if there were provisions that would have otherwise restricted the plans from offering the benefit.

CMS also developed a new Medicaid Section 1115 demonstration opportunity that can be used to extend home and community-based services (HCBS) flexibilities to beneficiaries receiving long-term services and supports (LTSS). These waivers provide states an avenue to test new approaches in Medicaid that differ from what is allowed by federal statute, such as certain non-clinical services to the Medicaid benefit package that can address food insecurity, among many other social determinants of health (SDOH).⁶

Many states’ Medicaid programs are also turning to Section 1915(c) waiver Appendix K, a somewhat obscure yet useful tool that helps ensure HCBS enrollees maintain their eligibility, protecting their access to much-needed services and support during the pandemic.⁷
The Families First Coronavirus Response Act (FFCRA), the “phase 2” legislative relief package signed into law on March 18, includes expansions in funding and authority measures to support various nutrition programs, including the Supplemental Nutrition Assistance Program (SNAP, formerly the Food Stamp program), food programs for schools, food programs targeting vulnerable communities, and food charities. Included in this bill is an additional $160 million to support home-delivered nutrition programs under the OAA.^{8, 9}
The Coronavirus Aid, Relief and Economic Security Act (CARES) Act, the “phase 3” legislative relief package signed into law on March 27, contains health-related provisions focused on the outbreak in the U.S., including paid sick leave, insurance coverage for coronavirus testing, nutrition assistance, and other programs and efforts. It also includes support for the global response.¹⁰

State response

Below are examples of how some states have been addressing the health and nutrition needs of their residents either prior to or in response to the coronavirus pandemic.

The Department of Health Care Services (DHCS) and California Department of Aging (CDA) announced on May 22, 2020 the development of a potential new “Long Term Care at Home" benefit in Medi-Cal for managed care and fee-for-service beneficiaries. As part of this new model of care, plans provide eligible consumers with a coordinated and bundled set of medical and home and community services, including nutrition services, to help vulnerable adults across the state stay healthy at home.¹¹While this initiative is not in response to COVID-19, it is a key focus that has taken on greater urgency.
Oregon’s Medicaid program established coordinated care organizations (CCOs) under its 1115 waiver in 2012 to better integrate and coordinate care for Medicaid enrollees. CCO’s have flexibility in the types of services delivered to enrollees that best lead to improved health outcomes and lower total costs of care. CCOs have continuously worked to combat a number of SDOH challenges, including food insecurity, in part through offering home-delivered meal benefits to enrollees.¹²
The Iowa Department of Human Services submitted section 1115, 1135, and 1915(c) waivers to CMS, seeking more flexibility to provide public assistance during COVID-19. These waivers would allow the State to, among other goals, provide home-delivered meals for non-waiver members who are home-bound, and waiver members where the waiver does not have meals as an allowable service. The waivers would also allow additional flexibility for HCBS providers to continue to meet member needs throughout the duration of the disaster proclamation.¹³
The Arizona Health Care Cost Containment System submitted a request to CMS to lift and/or alter several requirements related to the State’s Medicaid and Children’s Health Insurance Program (CHIP), citing section 1115 to expand the provision of home-delivered meals to all eligible populations.¹⁴

As COVID-19 continues, it is expected that the national and state governments will continue to address and develop new initiatives around the issue of food insecurity. At Mom's Meals^®, we remain focused on expanding our own operations to serve even more partners — thereby helping to meet the increased demand for nutritious, home-delivered meals for America's most vulnerable populations.

Sources:

1 https://www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-us/key-statistics-graphics.aspx#insecure

2 https://www.feedingamerica.org/sites/default/files/2020-05/Brief_Local%20Impact_5.19.2020.pdf

3 https://www.investopedia.com/what-is-the-families-first-coronavirus-response-act-4802576

4 https://crsreports.congress.gov/product/pdf/IF/IF10633

5 https://www.cms.gov/files/document/updated-guidance-ma-and-part-d-plan-sponsors-42120.pdf

6 https://www.kff.org/medicaid/issue-brief/medicaid-emergency-authority-tracker-approved-state-actions-to-address-covid-19/

7 https://www.kff.org/coronavirus-covid-19/issue-brief/how-are-states-supporting-medicaid-home-and-community-based-services-during-the-covid-19-crisis/

8 https://tcf.org/content/commentary/covid-19-lays-bare-vulnerabilities-u-s-food-security/

9 https://leadingage.org/regulation/oaa-and-cdbg-potential-partners-housing-providers

10 https://www.kff.org/global-health-policy/issue-brief/the-coronavirus-aid-relief-and-economic-security-act-summary-of-key-health-provisions/?gclid=EAIaIQobChMIouyh0-KL6gIVA-21Ch3pZwsdEAAYASAAEgLWGfD_BwE

11 https://www.dhcs.ca.gov/provgovpart/Documents/Medi-Cal-Long-Term-Care-at-Home-Benefit-Design.pdf