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 tailored 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 credential 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 produced, 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.
Medically tailored meals provided to enrollees of medical assistance programs must:
The Senate amendment requires that agencies prioritize the purchase of medically tailored meals from vendors that are able to provide locally sourced, rather than locally produced, meals. 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.
(In support) This bill sets consistent guidelines for medically tailored meals to ensure that patients receive the same standards of nutrition and care across the state. Thousands of Washingtonians are affected by medical conditions that require them to think strategically about the nutrients they put in their bodies. These meals help alleviate the impacts of chronic illness, like diabetes, heart disease, and kidney failure, while reducing hospitalizations and lowering healthcare costs. Local delivery drivers are able to connect directly with clients to combat loneliness. This is a model that works both economically and clinically.
When out-of-state, for-profit corporations are awarded contracts for providing medically tailored meals, state funds do not circulate through the state's own local economy. This bill will strengthen job opportunities for Washington residents by keeping procurement local for these meals when possible. This bill supports local jobs, the regional economy, and the patients who will receive medically tailored meals cooked in local kitchens and sourced from local suppliers.
(Opposed) None.
Representative Kristine Reeves, prime sponsor; Connie Gilfillan, Meals on Wheels People, Medically Tailored Meals Coalition of Washington; Emily Hanning, Lifelong Health for All, Medically Tailored Meals Coalition of Washington; Jeremy Vrablik, Cascadia Produce; Owen Esperas, Meals on Wheels Spokane, Medically Tailored Meals Coalition of Washington; Lianna Olds, Emergency Food Network, Medically Tailored Meals Coalition of Washington; and Jillian Moore, Mom's Micro Garden.