The Health Care Authority (Authority) administers the Medicaid program which is a state-federal program that pays for health care for low-income state residents who meet certain eligibility criteria.  Washington's Medicaid program, known as Apple Health, offers a complete medical benefits package to eligible families, children under age 19, low-income adults, certain disabled individuals, and pregnant women.

In November 2017 the federal Centers for Medicare and Medicaid Services (CMS) approved a program waiver for Washington, known as the Medicaid Transformation Project (MTP).  The MTP allows the Authority to receive federal Medicaid funding for several services and eligibility standards not generally recognized under the program.  In December 2024 the CMS approved the Authority's Health-Related Social Needs (HRSN) services protocol as part of the second iteration of the MTP.  The HRSN services funded under the MTP include interventions related to nutrition supports; housing and home environment; and case management, outreach, and education.  

Among the available nutrition support services are medically tailored meals which are defined as meals designed to support clients with health-related conditions for which nutrition supports would improve health outcomes.  The service includes assessments to develop a nutrition care plan, the provision of prescribed meals consistent with the nutrition care plan for up to three meals per day, and the delivery of the meal.  Medically tailored meals are available to Apple Health enrollees with chronic conditions who meet the United States Department of Agriculture definition of low or very low food security.  In addition, the enrollee must have been discharged from institutional care, a hospital, or a congregate setting within the prior six months or be at high risk of hospitalization or nursing facility placement.

The Department of Social and Health Services' proposed implementing rules require that providers of nutrition support services be approved by the state.  In addition, the rules only allow registered dietician nutritionists and primary care providers to develop nutrition care plans for medically tailored meals.

"Medically tailored meals" are defined as fresh or frozen meals that are designed by a qualified medical professional for the treatment of a person's medical conditions.  Qualified medical professionals include health care providers whose credentials include the authority to establish and tailor nutrition care plans to meet a client's needs.

If the Department of Social and Health Services or the Health Care Authority contracts with entities to provide medically tailored meals to enrollees of medical assistance programs, the agencies must, to the extent possible, prioritize vendors that are nonprofit organizations or small businesses that are able to provide locally sourced, fresh, whole foods, or from-scratch prepared meals.  Medically tailored meal vendors must comply with the client's nutrition care plan and have a qualified medical professional review and approve the menus provided in response to a nutrition care plan.  The term "locally sourced" is defined as either:  (1) agricultural commodities grown, raised, harvested, caught, or otherwise derived, fully or in part, within Washington; or (2) prepared, processed, assembled, cooked, or packaged, fully or in part, within Washington.

Medically tailored meals provided to enrollees of medical assistance programs must:

• align with evidence-based nutritional practice guidelines for treating the client's specific condition;
• offer accommodations in dietary needs, allergy restrictions, and cultural preferences;
• prioritize local, whole foods or from-scratch prepared meals;
• provide at least 500 calories or otherwise meet a client's medically appropriate energy needs; and
• provide one-third of the recommended dietary reference intakes for carbohydrates and protein, as established by the Food and Nutrition Board of the National Academy of Medicine.