Introduction

“Food Is Medicine” (FIM) is shorthand for a movement that aims to integrate food and nutrition into the modern healthcare system to prevent, manage, and treat various illnesses. Services typically include medically tailored meals, groceries, and/or produce boxes prescribed by a doctor or nutrition professional. Broader interpretations also include population-level healthy food programs, acknowledging the pervasive barriers to adequate nutrition, such as a lack of financial access, health literacy, time, skills, equipment, or social support.

In Hawaiʻi, food is medicine services (alternatively called “medically supportive food and nutrition services,” or simply “nutrition supports”) have existed in various forms for over a decade—supported in large part by private foundations and community benefits programs, and run by community-based food and nutrition organizations (referred to as CBOs in this report). These CBOs are essential, not only for client access to food, but also because they often play a critical role in connecting local farmers to consumers, nurturing a deeper connection between people and their food system.

It will take some additional effort to ensure that Hawaiʻi’s nutrition support services embrace this critical narrative; and to ensure that we develop systems that connect patients—not just to food, but to food that empowers local farmers and holds us accountable to ‘āina. 

Sustaining these community-driven programs in the long term will require integrating them into our modern healthcare system—a system many CBOs typically have had little interaction with in the past (beyond community benefits programs).  

One mechanism states can use to begin this process is what is known as the Medicaid Section 1115 demonstration waiver. This waiver authorizes states to use federal Medicaid funding to cover innovative services and financing mechanisms for a five-year test period. Hawaiʻi’s waiver was approved in January of 2025.

This report explores insights from selected Hawaiʻi-based and national innovators to help guide stakeholders through this transition. The report first provides a high-level overview of where we are now: what services are available in Hawaiʻi, including service delivery models and Hawaiʻi-based examples. The report then describes what is needed, summarizing feedback from stakeholders and briefly outlining the key systems and processes necessary to get CBOs set up to be reimbursed using Medicaid dollars. 

Finally, the report offers the following recommendations. Please note that these recommendations are not directed toward any particular agency, organization, or stakeholder group. Rather, they are intended to guide a collective partnership effort. The ultimate goal is putting Hawaiʻi’s Medicaid dollars to work, both to serve patients and to support Hawaiʻi’s community-based food systems.

1. Invest in Community Care Hubs (CCHs) and Network Leads.

2. Establish a Policy Advisory Body for Health-Related Social Needs (HRSN) Services.

3. Develop Cross-Sector Financial Partnerships.

4. Develop Model Contracts and Guidance for CBO partnerships.

5. Streamline Screening, Referrals, and Reimbursement Systems.

6. Develop Shared Goals and Metrics that Emphasize Local Food Procurement.

7. Designate Dedicated MCO-CBO Support Staff.