As SNAP benefits wane, food-as-medicine companies carve out a niche in healthcare

The end of COVID-era food and nutrition benefits is bringing an ebb to the Supplemental Nutrition Assistance Program (SNAP) in 32 states as of March 1. With a quickly approaching cliff and 18 states already having lost emergency benefits, digital food-as-medicine programs are bringing resources to the table.

Historically called food stamps, 41 million Americans receive the benefit that expanded at the beginning of the pandemic. At the end of the month, it is estimated that 16 million Americans will receive about $90 less a month. Some beneficiaries with the greatest need will lose up to $258 monthly, and further cuts are being proposed by Republican lawmakers who want more stringent eligibility requirements for the federal program.

Food-as-medicine programs have long been seen as a niche corner of healthcare. However, some even consider SNAP benefits as a food-as-medicine program. As value-based care gains traction, social determinants of health moves from a buzzword to common healthcare scaffolding and SNAP benefits get clipped, organizations like Instacart, FarmboxRx and About Fresh are expanding their reach.

“Our goal is to put more food on the table for more families,” said Instacart Chief Corporate Affairs Officer Dani Dudeck in a press release. “As grocery budgets tighten for millions of SNAP recipients and lines stretch longer at food banks across the country, accessing affordable, nutritious food has never been harder. At Instacart, we’re committed to finding more ways to support food banks nationwide so they can continue to serve their communities and feed more families.”

Instacart announced a Community Carts campaign along with an extension of its discounted Instacart+ membership for SNAP recipients. Anyone using an Electronic Benefit Transfer SNAP card to buy groceries on Instacart will continue to be eligible for a membership at half the standard price for one year.

By expanding its Community Carts initiative, the grocery tech company is hoping to drive donations to food banks. Starting March 1, food items can be donated via Instacart to over 120 food banks in 47 states with delivery service fees being waived.

Instacart’s food-as-medicine pillar includes various alliances such as Good Measures and its partner WellCare of Kentucky. The collaboration makes food prescription programs available to Medicaid members who have been screened for high blood pressure.

Currently, traditional Medicare is barred from covering food whether it be medically-tailored meals or produce prescriptions.

“While $90 a month may not seem like much to some people, it's a massive blow to the overall budgets of those who rely on SNAP to survive, especially during a period of record-high inflation,” FarmboxRx founder and CEO Ashley Tyrner told Fierce Healthcare in an email. “Dramatic cuts like this to SNAP budgets without alternative safety nets in place for those who have come to rely on these programs will trickle down to hit already over-burdened Medicare and Medicaid budgets.”

While food-as-medicine is still not covered by most insurers, reimbursement strategies are taking shape.

FarmboxRx is a food delivery service partnering with Medicaid and Medicare programs as an Advantage Benefit. Recipients may use an Over the Counter Card benefit or a Healthy Food Card benefit to purchase healthy food through the platform. People with private plans like Commonwealth Care Alliance and Health Partners Plans can also be reimbursed for medically tailored recipe boxes or produce.

Food-as-medicine programs have seen growing interest since September when the White House hosted the first Conference on Hunger, Nutrition and Health in 50 years. At the conference, private and public sector commitments totaled $8 billion for health and nutrition programs and research endeavors. Kaiser Permanente pledged $50 million to address key areas including coordinating with publicly funded programs to support members experiencing food and nutrition insecurity or diet-related diseases.

The Rockefeller Foundation and the American Heart Association along with inaugural partners including Kroger announced a $250 million plan to build a national Food is Medicine Research Initiative. Many experts in the field feel that what has been lacking is concrete evidence supporting the movement, a gap in knowledge the research initiative is hoping to fill.

About Fresh, a food-as-medicine startup, began addressing nutrition insecurity by turning school buses into grocery stores. When the nonprofit launched, Bostonians paid for produce with grant-funded coupons. Now, About Fresh provides a prepaid debit card.

About Fresh integrates its HIPAA-compliant platform into provider workflows including electronic health records and third-party referral platforms. Through integration with FIS, an IT service management company, cards can be used at Walmart, Kroger stores and Albertsons.

Founder and CEO Josh Trautwein has seen food-as-medicine gain traction as About Fresh has evolved with the movement. He sees a future where, like in the early stages of drug development, About Fresh functions as a nonprofit research laboratory. Only through this data collection can health systems learn prescription dosage, outcomes and limitations, Trautwein told Fierce Healthcare.

In December, the Rockefeller Foundation granted About Fresh nearly $900,000 to begin a “large-scale food is medicine demonstration project” with the VA. While the exact dimensions of the study have yet to take shape, Trautwein thinks it’s a first step to large-scale healthcare and government buy-in to addressing nutrition insecurity.

“It's almost more important than expanding our program because we want to contribute to the system's change in healthcare,” Trautwein said. “That's going to create the context for healthcare investment in food as medicine.”

Seana Weaver, Fresh Truck managing director at About Fresh, told Fierce Healthcare that "the end of the SNAP Emergency Allotments will create a huge strain for household food budgets throughout the country, especially those with children." She added that in Boston, the company's Fresh Truck Mobile Markets "are a place for families to stretch their SNAP dollars by using the Healthy Incentive Program to purchase fresh fruits and vegetables."

Policymakers face their own looming deadline with a federal law, known as the farm bill, authorizing agricultural subsidies and nutrition programs including SNAP set to expire at the end of September.

SNAP EBT cards themselves have also been a hot topic with recent waves of benefits being stolen. Unlike a debit or credit card which might warn of fraud, SNAP benefits have not always been historically protected. A lawsuit on behalf of New York state residents was filed this week against the Department of Agriculture to require the replacement of stolen funds.