Medi-Cal Medically Tailored Meals Program

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Frequently Asked Questions


Who is the California Food is Medicine Coalition (CALFIMC)?

The Cal FIMC is a group of medically tailored food and nutrition service providers across the state whose mission is to develop, refine, and sustain models where medical food nutrition services are an integral part of cost-effective and high quality health care in order to improve the health of all California communities. Members include Ceres Community Project, Food for Thought, The Health Trust, Mama’s Kitchen, Project Angel Food, and Project Open Hand.

What is the Medi-Cal Medically Tailored Meals Pilot Program?

The Medi-Cal Medically Tailored Meals Pilot Program is a medical nutrition intervention for Medi-Cal beneficiaries with a diagnosis of congestive heart failure. Aimed at reducing hospital and emergency department 30-day and 90-day readmissions, the Medi-Cal benefit includes complete nutrition of three meals per day, for 12 weeks and four medical nutrition therapy sessions during the intervention, at no cost to the patient.

The first-of-its-kind medical nutrition pilot program, California Senate Bill (SB) 97 was signed into law in June 2017 with $6 million dollars funding over a three-year period. The California Department of Health Care Services oversees the program, and will evaluate it at the end of the three years.

What is a medically tailored meal (MTM)?

Medically Tailored Meals (MTMs) are meals designed by a Registered Dietitian (RD) that reflect appropriate dietary therapy based on evidence-based nutrition practice guidelines to address a medical diagnosis, symptoms, allergies, medication management and side effects to ensure the best possible nutrition-related outcomes. [1]

How is the MTM Pilot Program service different from other traditional meal providers?

Services provided under the Medically Tailored Meals Pilot Program are designed as a congestive heart failure disease treatment program for those discharged from a hospital, emergency department, or a skilled nursing facility who are at the highest risk for hospital readmissions.

Daily medically tailored meals are offered for 12 weeks in conjunction with four medical nutrition therapy sessions and, if needed, information and referrals to other community-based services to promote adherence to the intervention. Meals are provided by a group of six community-based non-profit organizations with a collective 140 years of expertise in engaging professional staff, volunteers and funders to provide meals and support to individuals facing a serious illness, including many clients who do not qualify for other free and low-cost meal services.

How is medical nutrition therapy (MNT) different from nutrition education or counseling?

Nutrition counseling is a “supportive process to set priorities, establish goals, and create individualized action plans which acknowledge and foster responsibility for self-care.” [1] Medical Nutrition Therapy (MNT) goes further for disease management and includes nutritional diagnostic, therapy, and counseling services directed by a registered dietitian. Medical Nutrition Therapy includes the application of the Nutrition Care Process[2] designed to improve the consistency and quality of individual care for patients and the predictability of patient outcomes.

What does existing research tell us about the effectiveness of Medically Tailored Meals and Medical Nutrition Therapies?

In a study published April 2018, researchers found that participants that participate in Medically Tailored Meals programs result in a 16% net reduction in healthcare costs.[4]  The study suggests that medically tailored home-delivered meals are a cost-effective approach to managing the health of individuals with complex medical and social needs. There is a growing body of research demonstrating the benefits to health care costs and outcomes. When providing complete nutrition for six months, early studies are showing a 63% drop in hospitalizations and a 50% increase in adherence to medication among Type 2 Diabetes and/or HIV/AIDS patients in one 2017 study[5], and a 28 to 32% decline in overall health care costs in a 2013 study.[6]

Are all Medi-Cal beneficiaries eligible to receive Medically Tailored Meals?

If criteria is met, yes. All active Medi-Cal beneficiaries with full scope, no-cost coverage, who are being discharged from an inpatient stay resulting from an exacerbation of congestive heart failure can receive Medically Tailored Meal services.  

Why is the focus only on persons who are being discharged from a facility?

The unplanned readmission rate to a hospital after 30-days of discharge is as high as 14.5%[7], costing the state millions of dollars for preventable inpatient stays. In fact, it is estimated that across the country as much as $25 billion is spent on preventable readmissions.[8] We believe this intervention to be a cost-effective and patient-centered solution to this problem. The greatest opportunity to demonstrate the efficacy of this intervention for persons with congestive heart failure is at the point of hospital, emergency department, or skilled-nursing facility discharge.

What data or information will be used to demonstrate the effectiveness of the Medically Tailored Meals Intervention benefit?

The California Department of Health Care Services will be recruiting evaluators who will use Medi-Cal utilization and claims data to measure the outcome of the pilot program. Additional data may be collected at the point of service to improve the operation and implementation of such programs.

Footnotes

[1] Academy of Nutrition and Education. Accessed at:https://www.eatrightpro.org/payment/coding-and-billing/mnt-vs-nutrition-education

[2] Academy of Nutrition and Education. Accessed at: https://www.eatrightpro.org/payment/coding-and-billing/mnt-vs-nutrition-education

[3] Academy of Nutrition and Education, Evidence Analysis Library. Accessed at: https://www.andeal.org/ncp

[4] Seth A. Berkowitz, Jean Terranova, Caterina Hill, Toyin Ajayi, Todd Linsky, Lori W. Tishler, and Darren A. DeWalt. Meal Delivery Programs Reduce The use of costly health care in dually eligible medicare and medicaid beneficiaries, Health Affairs vol 37, no 4 Accessed at: https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2017.0999

[5] Palar, K., Napoles, T., Hufstedler, L.L. et al. J Urban Health (2017) 94: 87. Accessed at: https://doi.org/10.1007/s11524-016-0129-7

[6] Published online Journal of Primary Care & Community Health June 3, 2013 doi: 10.1177/21500131913490737

[7] Data available from Let's Get Healthy California - Accessed at: www.letsgethealthy.ca.gov

[8] Kocher RP, Adashi EY. Hospital readmissions and the Affordable Care Act: Paying for coordinated quality care. JAMA. 2011;306(16):1794-1795.

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