Laura Siller, PhD
Food insecurity is a pressing public health issue with far-reaching consequences. Limited or uncertain access to nutritious food is closely linked to a range of adverse health issues, including chronic disease, mental health challenges, and increased hospitalizations. The health care system, with its broad reach and ongoing relationship with patients, is uniquely positioned to identify individuals at risk of or currently facing food insecurity and connect them to vital food and nutrition resources. Integrating food security initiatives into health care delivery presents a powerful opportunity to intervene upstream and promote health equity across communities.
MassHealth, Massachusetts’ Medicaid program, recognized the importance of addressing social determinants of health years ago through its pursuit of the 1115 waiver. This federal waiver grants states the opportunity to innovate beyond standard Medicaid rules. Through it, MassHealth has been able to fund non-traditional services, such as nutrition and housing support, acknowledging that health is shaped not just by clinical care, but by everyday conditions that affect people’s lives such as access to nutritious food and stable housing.
Medicaid is a federal and state program that helps cover medical costs for people with limited income and resources. While the federal government provides general guidelines, each state manages its own program, so eligibility and benefits can vary by state.
As the budget reconciliation process moves forward, significant cuts to Medicaid are on the horizon. The House version of the budget reconciliation bill, which passed on May 22, includes $715 billion in cuts to Medicaid, which is known as MassHealth in Massachusetts. Governor Healey’s Office estimated that these cuts would amount to a loss of $1.75 billion a year for Massachusetts and would result in the loss of healthcare coverage for 250,000 residents. Projections also indicate that such cuts could result in the loss of approximately 17,300 jobs and a reduction of $141.3 million in state tax revenue in 2026 alone. This significant reduction in revenue and funding would force the state to make decisions about cutting programs or services for MassHealth members. To put that in perspective, nearly 2 million vulnerable Massachusetts residents, including over 725,000 children, would bear the brunt of these devastating cuts.
While we have been waiting for news on federal funding, the Centers for Medicare & Medicaid Services is taking other steps to limit the availability of services through Medicaid. They have rescinded previous guidance that encourages states to use Medicaid to cover non-medical expenses for nutrition assistance and housing stability. These services are part of a broader effort to allow Medicaid to address social determinants of health like food insecurity that have been proven to adversely affect health and well-being.
Why does that matter? Because addressing food insecurity through nutrition support could save us a lot of money. Indeed, a recently released study by researchers at UMass Chan Medical School found participation in Massachusetts nutrition services programs funded via Medicaid was associated with a decrease in hospitalizations and emergency room visits, and savings of $2,502 in health care costs per adult.
As the largest nutrition service provider in the state, Project Bread is proud to have played a role in these important outcomes. Our pilot program, funded under our state’s 1115 waiver, served over 17,000 Medicaid patients between 2020 and 2024. An evaluation of our pilot program revealed promising results, including a significant increase in food security among patients, a milestone we are incredibly proud of. Since transitioning to MassHealth’s Health-Related Social Needs (HRSN) program this winter, our work continues to expand access to nutritious foods, support long-term health outcomes, and reduce strain on our healthcare system.
Ultimately, these improvements reflect the transformative impact of integrating nutrition services into healthcare, highlighting the value of scaling interventions that meet patients’ basic needs as part of their care. Rollbacks or reversals of the HRSN services would stall innovation, reduce funding certainty, and limit the ability of dozens of social service organizations that deliver nutrition support through Medicaid. All told a gigantic step backwards in progress.
Now is the time to act. Cuts to Medicaid threaten critical services like nutrition support that improve health, increase food security, reduce costs, and strengthen communities. Project Bread’s work proves what’s possible when we treat food as medicine, but we cannot do it alone. We urge lawmakers and advocates to oppose these cuts and protect the progress we have made.
Let's urge Congress to protect Medicaid and SNAP.