A patient with diabetes, hypertension, and kidney disease leaves a clinic with a familiar set of instructions: eat more fresh produce, reduce sodium, avoid processed foods, take medications on time, and come back for follow-up. But at home, the refrigerator is nearly empty. The nearest grocery store is expensive. The bus is unreliable. Wages aren’t going to stretch to the end of the month. The local food pantry is already overwhelmed. By the time this patient returns to the emergency department with uncontrolled blood sugar or dangerously high blood pressure, the healthcare system is ready to pay for the crisis. Yet it has been far less willing to pay for the food that might have helped prevent it.
This is the paradox at the heart of chronic disease care: we prescribe routines that depend on stability while many patients are living with scarcity. For the 1.4 million New Yorkers experiencing food insecurity, that scarcity can follow them directly into the exam room. Food insecurity is not simply about hunger; for people with chronic conditions, it can determine whether a care plan is even feasible. Adults experiencing food insecurity are two to three times more likely to have type 2 diabetes, and for those already living with diabetes, food insecurity is associated with higher A1C levels, complications, hospitalizations, and poorer mental health.
The burden is not evenly distributed. In 2024, more than one in ten New Yorkers reported food insufficiency, a measure of not having enough to eat in the previous week. Black and Hispanic New Yorkers experienced food insufficiency at roughly twice the rate of white New Yorkers, and New Yorkers earning less than $25,000 annually experienced 13 times the rate at 29.1%, compared with just 2.2% among those earning $100,000 or more.
Policymakers cannot keep labelling these outcomes as “disparities” while ignoring the material conditions that produce them. Healthcare often frames poor outcomes as individual failures of missed appointments, poor diet, and uncontrolled disease. But food insecurity changes the interpretation. A patient may not be ignoring medical advice; they may be triaging survival. Non-adherence is often what we call poverty when it appears in a medical chart.
This is especially true for Medicaid patients with complex chronic disease, whose health needs rarely exist in isolation. Managing one chronic illness is difficult under food insecurity; managing several can become nearly impossible. These medical challenges are often compounded by unstable housing, transportation barriers, low wages, caregiving responsibilities, and limited access to specialty care. Food insecurity does not simply add another burden — it magnifies every existing one.
In New York, Medicaid is not a marginal program but a central pillar of the healthcare system, covering more than 6.4 million people statewide, including more than 3.6 million in New York City alone. Thus, Medicaid is uniquely positioned in this discourse because it serves many of the patients living at the intersection: low-income, medically complex, and structurally marginalized. If Medicaid is serious about improving chronic disease outcomes and reducing racial health disparities, it must treat food-related interventions, such as medically tailored meals, produce prescriptions, and nutrition counseling, not as extras but as practical chronic disease tools.
New York is now testing this premise through its Medicaid 1115 waiver, which describes a $7.5 billion, three-year package running through March 31, 2027, with food-related services including nutritional counseling, medically tailored home-delivered meals, food prescriptions, and cooking supplies. Rather than treating these needs as separate from healthcare, New York’s experiment recognizes that chronic disease management depends on whether patients can actually access the resources their care plans require.
This experiment should force a national conversation on if Medicaid can move from a sick-care model to a prevention-and-stability model. If food insecurity predictably worsens chronic disease, nutrition support should not depend on the philanthropy of overburdened food pantries. Community organizations have long filled gaps that the healthcare system helped create, but relying on charity is not sustainable.
And, the economic case is as clear as the moral one. Medicaid already pays for the downstream consequences of food insecurity: emergency visits, preventable readmissions, and post-acute care. Medically tailored meals will not solve chronic disease alone, but refusing to pay for nutrition support while paying for avoidable complications is clinically incoherent and fiscally shortsighted.
The question is not whether Medicaid should become a food program. The question is whether Medicaid can keep pretending food has nothing to do with the diseases it already pays billions to treat. Medicaid patients with complex chronic disease do not need another pamphlet telling them to eat better. They need a healthcare system honest enough to admit that chronic disease care depends on food security. If Medicaid can pay for the hospitalization, it should also be able to pay for the meal that helps keep a patient stable at home. New York’s experiment is not radical because it treats food as medicine. It is radical because it asks why healthcare waited so long.
Author’s Bio: Jeanette Nguyen is a second-year Master of Public Health student at Columbia University in the Sociomedical Sciences department with a certificate in Health Promotion Research and Practice. Jeanette’s commitment to supporting immigrant communities reflects years of community-engaged research and service, where she has worked to bridge gaps in healthcare access and education. She hopes to integrate her multidisciplinary background and dedication to social justice into a career advancing inclusive solutions that address systemic disparities and promote culturally competent care.
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