Medicaid Nutrition Supports Associated with Reductions in Hospitalizations and Emergency Department Visits in Massachusetts

• In Event: Addressing Health-Related Social Needs Through Medicaid: Findings From 1115 Waivers Across States

Abstract

Introduction / Background: In 2020, the Massachusetts Medicaid and the Children’s Health Insurance Program (MassHealth) the Flexible Services Program (FSP) under its 1115 Demonstration to address food insecurity through nutrition supports delivered through partnerships between accountable care organizations (ACOs) and social service organizations (SSOs). Services included medically tailored meals, home delivered meals, food boxes, produce prescriptions, grocery vouchers, kitchen supplies, and nutrition education. We evaluated the effects of nutritional FSP on healthcare utilization and costs during the first 3-year program cycle (January 2020 - March 2023), which pooled participants across 44 nutrition programs implemented by 17 ACOs in partnership with 16 SSOs across Massachusetts. 

Methods: The study included Medicaid ACO enrollees participating in nutritional FSP versus a comparison group of ACO enrollees screened as eligible to participate. We conducted a quasi-experimental study using Medicaid claims and encounters data from 2019-2023. Primary outcomes included unplanned inpatient admissions, emergency department (ED) visits, and total healthcare costs during FSP enrollment. Overlap propensity score weighted generalized estimating equations compared changes in outcomes from 6-months prior to enrollment to the FSP period. Propensity score models included baseline socio-demographic, geographic, clinical, healthcare utilization, and healthcare cost covariates that may act as confounders. 

Results: The study population included 20,403 FSP participants and 2,018 comparators. In total, 15,557 adults (mean age 44.7 years) and 4,846 children (mean age 9 years) enrolled in nutritional FSP. FSP enrollment ranged from 3 to 1004 days, with a mean of 4.6 months. FSP participation was associated with lower hospitalization (aIRR: 0.77; 95% CI: 0.65, 0.90) and ED visit rates (aIRR: 0.87; 95% CI: 0.80, 0.95), while rates of primary care visits were unchanged (aIRR: 1.00; 95% CI: 0.99, 1.03) versus comparators. In secondary analyses among 8,641 adults enrolled for >90 days, FSP participation was associated with a significant reduction in total healthcare costs of $2,502 (95%CI: -$4,641, -$363). This reduction in healthcare costs was greater than the average per-person costs of administering FSP ($2,292 / person), resulting in approximately $1.8 million in associated cost savings for this subgroup. Differences in primary outcomes were not statistically significant in secondary analyses among children, including those enrolled for >90 days. 

Conclusions / Implications: Medicaid-funded nutrition supports for over 20,000 members with food insecurity was associated with a 23% reduction in hospitalizations and 13% reduction in ED visits as compared to eligible non-participants. Among adults with >90 days enrollment, healthcare cost savings during the period of enrollment were estimated to offset program costs. These findings are important for Medicaid policy nationwide as several states have approved or pending Section 1115 Waivers to pilot similar “Food is Medicine” programs.

Authors

• Matthew Alcusky, UMass Chan Medical School
  Non-Presenting Co-Author

• Kurt Hager, UMass Chan Medical School
  Presenting Author