Study Sponsor: Dana-Farber Cancer Institute

Evaluation of Project Bread’s Flexible Services Program

Study Summary

In 2020, MassHealth launched its Flexible Services Program (FSP), a groundbreaking pilot that allows Medicaid dollars to be used on “non-medical” expenses. The FSP is intended to address social determinants of health such as food insecurity. Multiple Accountable Care Organizations (ACOs) in Massachusetts have partnered with Community Based Organizations (CBOs) to provide FSP services to eligible clients across the state. Each CBO may offer a different set of services under the FSP. Project Bread is the non-profit CBO partner of Community Care Cooperative (C3) to address chronic food insecurity in patients with complex medical conditions via the health care sector, in an effort to improve long-term health outcomes.

The Dana-Farber Cancer Institute has funded Project Bread for the first year of a three year-long study to determine the impact of Project Bread’s FSP model on the food security and health of traditionally marginalized populations in Massachusetts. Project Bread has designed an innovative, choice-based nutrition intervention in collaboration with C3 for food insecure patients with chronic physical and/or mental health conditions. The intervention provides various goods and services that address individual barriers to access food such as financial support, kitchen supplies, education, and transportation. Project Bread’s research aims to:

  1. Measure change in food insecurity status among Project Bread’s FSP clients after they have completed the program.

  2. Evaluate the impact of Project Bread’s nutrition services.

  3. Collect program implementation data from FSP Community Health Workers (CHWs) andclients to improve Project Bread’s delivery of nutrition services for the FSP.

To achieve these three aims, Project Bread will collect data from CHWs at C3 and from former clients of the Flexible Services Program. This information will help Project Bread to determine the most effective and efficient service and treatment options for Flexible Services clients. Additionally, Project Bread will use the information from the study to amplify the voices and experiences of clients and community health care workers to advocate for the inclusion of the Flexible Services program into policy changes.

Study components

  • 14 interviews with Community Health Workersat C3 health centers

  • 8-10 focus groups withformers FSP clients

  • 150-200 surveys withformer FSP clients


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This study has been reviewed and approved by MassHealth, C3, and the Harvard Longwood Campus Institutional Review Board.

Participant Resources

Focus Group Consent Form

Participant Resources

Phone Survey Consent Form