Federal budget cuts may force some states to end meal delivery for Medicaid patients On a weekday morning in a quiet Boston neighborhood, a kitchen bustled with activity. Volunteers sliced chicken breasts, stuffed bell peppers, filled trays, and carefully labeled each item.

It was part of an experiment to offer nutritious and medicall- tailored meals to Medicaid patients who are unable to shop for groceries and cook for themselves. "Once I started to eat these meals that were geared toward my illness, I built up my muscle mass again, built up my strength, built up my confidence in myself," said Vanessa Georges, who is in remission from throat cancer and said she would struggle to consume enough calories without the deliveries. "These meals have given me a second chance." Georges said she noticed another benefit from the meals: She spends less time at the doctor's office.

Researchers have found evidence backing her observation. About 1,900 Massachusetts residents who, like Georges, received medically-tailored meals for at least three months needed less medical care, according to a study published in the journal Nature Medicine. They had 20% fewer emergency department visits and 31% fewer hospitalizations than similar patients who did not receive meals. "It actually saves the healthcare system money," said Dariush Mozaffarian, a cardiologist and professor at Tufts University who led the study. "That's a really big deal, because most things in healthcare don't." The research from Massachusetts adds to evidence that medically-tailored meals could save states money — in addition to improving health. Yet such programs could land on the chopping block as states look to tighten spending under Trump administration budget cuts, even as federal officials argue that food is a critical component of health.

Medicaid budget cuts loom The 2025 law known as the One Big Beautiful Bill Act slashed projected Medicaid funding by more than $900 billion. Many Republicans who backed the bill believe federal health spending is too high and riddled with fraud. Sen. John Kennedy, a Louisiana Republican, for example, has accused California of "outrageous fraud" for using Medicaid dollars to fund housing and nutrition programs.

Amaya Diana, a policy analyst at KFF, said states will have to make tough choices in the next few years as they figure out how to fill funding gaps. "If states are not able to offset the loss of federal funds with new taxes or reductions in other state spending, they may have to make program cuts," she said. (KFF is a health information nonprofit that includes KFF Health News.) Thirteen states have received federal waivers to use Medicaid dollars to pay for meals — part of an approach known as "food is medicine." Three other programs are awaiting federal approval.

President Donald Trump's support for social services has wavered. While the first Trump administration allowed states to pursue medically-tailored meals and other social supports, the second Trump administration rescinded Biden-era guidance for Medicaid initiatives that address social needs. It hasn't detailed a new policy.

Administration officials have warned that they will be more focused on the budget impacts of such initiatives. "They signaled they're going to be a lot more skeptical," said Kurt Hager, an assistant professor at the University of Massachusetts Chan Medical School who studies nutrition programs and helped lead the Massachusetts study. "Instead of using a broad-based approach nationwide, they're going to make decisions on a state-by-state basis." At the same time, health leaders in Trump's administration have made nutrition a major focus, including by promoting less-processed foods. Robert F. Kennedy Jr., who leads the Department of Health and Human Services, and Mehmet Oz, administrator of the Centers for Medicare & Medicaid Services, have pushed hospitals to serve healthier foods to boost patient outcomes.

The healthcare system is often willing to pay for surgeries, Oz said in a social media video in June, "but not always willing to pay for the nutrition that might help prevent those outcomes in the first place. That's bothered me my whole career." He added that the agency is evaluating several strategies, including medically tailored meals, to prevent illness and hospitalization. CMS officials did not respond to several emailed requests for comment for this article.

Katie Garfield, who studies social determinants of health at Harvard Law School's Center for Health Law and Policy Innovation, said the lack of federal guidance is stirring uncertainty for states that want to pursue nutrition programs in Medicaid. "We're still waiting to see that big step forward around 'food is medicine' interventions," she said. "We need to see that step forward to resolve some of the uncertainty." Lawmakers have had a hard time engaging administration officials on medically-tailored meals, said U.S. Rep. Jim McGovern, a Massachusetts Democrat, who sponsored a bill that would pilot meal deliveries for some chronically-ill seniors on Medicare. The legislation has yet to come up for a vote.

"I had thought, based on some of his rhetoric before he entered the Trump administration, that RFK Jr. would be a natural ally on this," McGovern said. "But we can't seem to get his attention." The costs of poor nutrition Some companies have been accused of billing Medicaid for meals that were neither healthy nor nutritious, raising concerns about lax regulation of these programs.

But at Community Servings in Boston, the food is prepared with specific attention to sugar, salt, fat, vitamins, and minerals and is based on a person's health needs, said David Waters, chief executive of the nonprofit. Many recipients require food that is mild or low in fiber, for example.

"What we're able to do is to work with your healthcare provider to understand your health realities — what your diagnoses are, what your medications are, side effects, food allergies, cultural norms — and then prescribe a diet for you that is scratch-made," Waters said.

The Massachusetts researchers found that the meals — at a cost of $125 per person per week — essentially paid for themselves. Patients with heart disease used about $10,000 less in healthcare services over six months, and patients with kidney disease used $12,000 less in healthcare. There were also savings for people with diabetes, depression, and anxiety.

The Massachusetts researchers found that the meals — at a cost of $125 per person per week — essentially paid for themselves. Patients with heart disease used about $10,000 less in healthcare services over six months, and patients with kidney disease used $12,000 less in healthcare. There were also savings for people with diabetes, depression, and anxiety.

"Those are pretty big numbers when you think of how expensive those diseases can be and the prevalence in the population," Waters said.

Nationally, researchers estimate, 10 million Americans would benefit from medically tailored meals, though only a small fraction are enrolled. "Poor nutrition is the top cause of poor health in this country. It's the top cause of preventable healthcare spending," said Mozaffarian, director of the Food is Medicine Institute at Tufts. He has estimated that medically tailored meals could help patients avoid 1.6 million hospitalizations and save the U.S. $13.6 billion in healthcare costs each year.

A weekly delivery that makes a difference Steve Honyotski receives 10 meals at his Boston home each week, cooked fresh and delivered cold or flash-frozen. They're ready to eat after just a couple of minutes in the microwave.

"The carrot ginger soup is my favorite," Honyotski said. Honyotski, 71, lives with several chronic conditions, including diabetes, obesity, and high blood pressure. He said he's noticed improvements in his health since he started eating medically tailored meals. He needs less insulin to control his diabetes, and he's lost enough weight to delay a knee replacement surgery.

For now, those meals will keep coming. And Massachusetts' Medicaid director, Ryan Schwarz, said the state will seek federal approval to continue medically tailored meals in the coming years. "We feel very strongly committed to continuing these services," he said.

In North Carolina, researchers found that food and housing supports lowered Medicaid spending over time. Yet North Carolina state lawmakers suspended the services in 2025 over budget worries. After budget deliberations this summer, state legislators changed course and decided to partially fund the program.

"To me, that's a signal of what might occur in other states as these Medicaid cuts hit," said Hager, the UMass researcher. "Even though they have the authority to run these programs, it might be a lot harder for the states to actually implement them." This story comes from NPR's health reporting partnership with WBUR and KFF Health News.