The Health Care Authority (HCA) 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.  Apple Health, Washington's Medicaid program, offers medical benefits to eligible families, children under age 19, low-income adults, certain disabled individuals, and pregnant women.

In December 2024, the federal Centers for Medicare and Medicaid Services approved the HCA's Health-Related Social Needs (HRSN) services protocol.  HRSN services include interventions related to nutrition supports, among other things. One of the nutrition support services is medically tailored meals, which are 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.  The enrollee must also 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 (DSHS) will administer the program, which is being implemented.  Their implementing rules require that providers of nutrition support services be approved by the state and that registered dietician nutritionists and primary care providers develop nutrition care plans for medically tailored meals.

If DSHS or HCA 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 are to comply with the enrollee's nutrition care plan and have a qualified medical professional review and approve the menus. 

All medically tailored meals provided to enrollees of medical assistance programs must:

• align with evidence-based nutritional practice guidelines for treating the specific condition; 
• offer accommodations in dietary needs, allergy restrictions, and cultural preferences;
• prioritize local, whole foods or from scratch prepared meals unless otherwise required to appropriately meet the needs of the enrollee;
• provide at least 500 calories, or otherwise meet a client's or enrollee'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, unless otherwise permitted.

Medically tailored meals means a fresh or frozen meal that is designed by a qualified medical professional for the treatment of one or more medical conditions of a client.

A medically tailored meal vendor is a vendor that provides medically tailored meals according to specifications from a qualified medical professional.

A qualified medical professional is a person who holds a credential issued by a disciplining authority regulated by the Department of Health and whose credential includes the authority to establish and tailor nutrition care plans to meet the medical needs of enrollees of medical assistance programs.

No public hearing was held. 

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