With approval of Hawaiʻi’s Section 1115 Medicaid Demonstration Waiver, community-based food and nutrition organizations can soon begin to offer healthy food as medicine.

HONOLULU, Hawaiʻi — Community-based food and nutrition organizations (CBOs) in Hawaiʻi have long understood that nutrition and healthy food are key factors in maintaining good health. With the approval of Hawaiʻi MedQUEST’s Section 1115 Medicaid Demonstration Waiver this month, these providers can soon take advantage of Medicaid dollars to expand their services.

The 5-year waiver allows the state to try out new or innovative approaches to delivering healthcare services that differ from what is normally allowed under federal rules. For the first time, Hawaiʻi’s waiver now authorizes Medicaid coverage of “nutrition support services,” acknowledging the widely accepted notion that food is medicine.  

“‘Food Is Medicine’ is shorthand for a movement that aims to integrate food and nutrition into the modern healthcare system to prevent, manage, and treat various illnesses,” said Daniela Spoto, Hawaiʻi Appleseed Director of Food Equity. “Sustaining the community-driven programs that have been advancing this philosophy in the long term will require integrating them into our modern healthcare system. That’s what this waiver helps to achieve.”

“The approval of Hawai’i’s Medicaid 1115 waiver is a transformative step in connecting healthcare with local food systems,” said Lucas McKinnon, Managing Director of Hawaiʻi Good Food Alliance. “By fostering collaboration among healthcare providers, local community-based organizations, and farmers, we are building healthier communities rooted in ʻāina accountability. Medicaid’s role is pivotal, but this is just the start—we will continue advocating for sustainable funding for locally sourced Food is Medicine initiatives through our Community Care Hub model.”

Services authorized by the waiver include nutrition education, as well as programs that offer the direct provision of food, such as medically-tailored meals, produce prescription programs, and restocking home pantries. Notably, Hawaiʻi’s waiver is one of the few that explicitly supports local food procurement, reinforcing our communities’ commitment to both public health and local agriculture.

To guide the successful integration of these services, Hawaiʻi Appleseed—with support from the Harry and Jeannette Weinberg Foundation and Stupski Foundation—has released a report titled “Food is Medicine: An Assessment of Hawaiʻi’s Food and Nutrition Services Landscape.” The report draws on direct feedback from Hawaiʻi CBOs to identify both challenges and opportunities for expanded nutrition services in the state. The report provides recommendations for next steps, taking into consideration this local feedback and drawing on models that have been developed in other states:

1. Invest in Community Care Hubs (CCHs) to centralize administrative functions and support CBOs in partnering with Medicaid to provide nutrition services. These hubs can streamline referrals, billing, and data sharing between healthcare providers and community organizations.

2. Establish a policy advisory body to oversee the integration of Health Related Social Needs (HRSN) services, engage stakeholders across sectors, offer policy recommendations and ensure alignment with state health goals.

3. Develop cross-sector financial partnerships between public entities and private funders to ensure the sustainability of nutrition services.

4. Create model contracts for CBOs and provide guidance to facilitate their entry into Medicaid partnerships and help them meet the necessary administrative requirements.

5. Streamline screening and reimbursement systems. Simplifying these systems is crucial for ensuring that CBOs can focus on service delivery rather than administrative burdens.

6. Establish shared goals and metrics, particularly around local food procurement, to measure success in both health outcomes and support for local agriculture.

7. Designate Medicaid managed care organizations (MCOs) to have dedicated staff who can assist CBOs and patients with technical support, billing, and referrals.

“The release of Hawaiʻi Appleseed’s report comes at a pivotal time, as Hawaiʻi prepares to implement its Section 1115 waiver,” said Spoto. “With a strong focus on integrating nutrition supports into Medicaid and fostering local food systems, Hawaiʻi is poised to lead in both healthcare innovation and sustainable food production. The report’s recommendations provide a roadmap for ensuring that these services are effectively rolled out, benefiting both patients and local communities.”