Medi-Cal delivers ready meals as part of a great healthcare experience

Last updated on May 29, 2022 by BVN

A new Medi-Cal initiative known as CalAIM is designed to save program expenses by providing social services, including helping clients find housing, removing toxic mold from their homes and delivering food medically appropriate. Unconventional offers are administered by medical plan providers rather than social services, as is customary. Insurers can also decide which services CalAim offers and who can benefit from them.

California has embarked on an ambitious five-year initiative to improve the health of its sickest Medicaid patients by introducing non-traditional services. In the Inland Empire, where many residents suffer from diabetes, a health plan dives into the experience by delivering healthy, prepared meals to those lucky enough to get them.

Heidi by Marco and Angela Hart | KHN

Every Friday, Frances De Los Santos waits for a shipment of healthy, prepared meals to land on her porch on the edge of the Mojave Desert. From the box, the 80-year-old retired property manager with stage 4 chronic kidney disease unpacks trays of frozen food she can reheat in the microwave. Her favorite is sweet and sour chicken.

In the three months since she started eating the personalized meals, De Los Santos has learned to manage her diabetes by maintaining healthy blood sugar levels.

Frances De Los Santos of Victorville, Calif., is getting medically-appropriate meals delivered to her home as part of a new Medi-Cal program aimed at improving the health of her sickest patients. (Heidi de Marco/KHN)

Two hours further south, in Indio, Vidal Fonseca is preparing for his third dialysis appointment of the week. He too struggles with kidney disease and diabetes. The 54-year-old former farm worker was released from hospital in November ordered to follow a strict diet, but he is making a mess in the kitchen and struggling to control his blood sugar. He does not receive prepared meals.

Here in California’s vast Inland Empire, where more than half of adults have diabetes or are at risk of developing diabetes, a health plan provides medically-appropriate meals for select patients. By bringing food straight to their doorsteps for a few months, state officials hope patients will develop healthier eating habits long after the shipments stop. It’s all part of a grand state experiment to improve the health of some of its sickest and most expensive patients.

What is CalAIM?

The five-year California initiative, known as CalAIM, will test whether Democratic Gov. Gavin Newsom can slow government spending on Medi-Cal, the state’s Medicaid program for low-income people, which has spiked in soared to $124 billion this fiscal year, up nearly three times from a decade ago. Medi-Cal managed care insurers will try to keep people out of expensive health care facilities by providing social services, such as helping patients find housing, removing toxic mold from their homes, and delivery of medically adapted food.

CalAIM, which is expected to cost $8.7 billion, is unconventional because it is primarily implemented by health plans, not county social services. It will only serve a fraction of the 14.5 million Californians enrolled in Medi-Cal. And the state is still developing a way to track health outcomes, which means no one knows yet if it will save money.

“It’s a new program, and often with new programs you build the plane as you fly it,” said Shelly LaMaster, director of integrated care at the Inland Empire Health Plan.

Delivery of meals and food boxes

The health plan is one of two Medi-Cal managed care insurers serving San Bernardino and Riverside counties and has approximately 1.5 million enrollees. Inland Empire Health Plan says about 11,000 of its enrollees will be eligible for meal and food box deliveries. The average meal allowance is worth $1,596 and lasts for three months, although health insurers can choose to extend food deliveries.

Because the plans decide which enrollees receive services, many worthy patients — even those enrolled in the same plan or who live in the same county — are being left out. In the Inland Empire, some patients have started receiving food while others are still enrolling. So far, 40% of recipients are Hispanic, 35% are white, and 18% are black, matching the demographics of the region. (Hispanics can be of any race or combination of races.)

Initial deliveries for most attendees will be frozen entrees, ranging from taco bowls to chicken curry. Later, they can receive boxes filled with fresh fruit, vegetables, wholemeal bread, pasta and rice so they can prepare their own meals.

De Los Santos is among the 720 lucky registrants who have been approved for the benefit since January. Participants must be referred to the program, but referrals can come from physicians, community groups, and family members — Medi-Cal enrollees can even refer themselves.

De Los Santos’ case manager identified his need after conducting an assessment. Next, a dietitian screened her for her food preferences and health issues to develop a nutrition plan.

Her first box of nutritionally-appropriate meals arrived in February from Mom’s Meals, one of two prepared meal companies under contract with the Inland Empire Health Plan. Each week, she receives convenient microwave-ready meals and an information sheet with the macronutrient breakdown of each dish.

Vidal Fonseca from Indio, California relies on his wife and daughter to cook his meals. Fonseca said receiving medically appropriate meals would ease the burden of cooking and guesswork for them. (Heidi de Marco/KHN)

“I’m on a meal schedule now,” she said. “I eat a lot of meats, salads and vegetables, like broccoli and cauliflower, which are good for me.”

Meanwhile, Fonseca, also enrolled in the Inland Empire Health Plan, relies on his wife and daughter to figure out how to get his diabetes under control. After being diagnosed in November, they rushed to learn how to cook for him by researching recipes online.

“Before he was diagnosed with kidney disease, he was on a diet high in iron-rich foods, like lentils and beans, but not good for kidney disease,” said his 29-year-old daughter, Maria Cruz. “We were giving him poison.”

Fonseca said he had heard of food banks, but not of meals delivered to homes. “The menu for someone in my condition with both kidney failure and diabetes is very limited and specific,” he said in Spanish. “Talking to a nutritionist and receiving free meals specially prepared for me would be a big help.”

Insurers at the helm

But even if his conditions would qualify him for meal delivery, it is up to the insurer to register him.

Participating in the program would ease the guesswork for his wife and daughter. Fonseca’s wife, Eufracia Constantino, still works in the fields. She gets up at 4:30 a.m. to cook her breakfast every morning before leaving for work. His daughter makes him lunch, which usually consists of chicken or fish, sautéed vegetables and hard-boiled eggs.

“I usually drove trucks with a burrito in one hand and the steering wheel in the other,” said Fonseca, who was a farm truck driver.

De Los Santos, who until recently was the breadwinner, had to adjust to becoming a patient. Two months ago her husband, Fermin Silva, became her state-funded paid carer and the couple are struggling to pay rent and utilities. To save money, they will move into a two-bedroom mobile home next month.

“Now I don’t have to worry about buying my meals anymore,” she says. “I would say I saved about $150 a month.”

As she saves money, Fonseca spends an extra $100 a week to buy healthy food that her wife and daughter prepare for her.

“We had to stretch my wife’s salary,” Fonseca said. “We don’t fill the grocery cart like we used to.”

The California Department of Health Services, which operates Medi-Cal, hopes that patients who receive medically tailored meals will use the healthcare system less often. The goal is to improve people’s health by empowering them to adopt better eating habits and learn how to maintain a healthy diet. Although some recipients may have irreversible conditions, such as congestive heart failure or severe diabetes, officials still see opportunities to reduce hospital admissions and emergency room visits.

Studies have shown that providing meal delivery services helps reduce healthcare costs. State officials note that food benefits will be expanded over time and that there is no price cap for the initiative.

But the health agency could not provide data on the number of Medi-Cal patients eligible for food delivery and will not report the number of people receiving the service until later this year. The state plans to evaluate the cost-effectiveness of these social services as the program expands, according to agency spokesman Anthony Cava.

Measure the impact

Inland Empire Health Plan officials say it could be difficult to pinpoint the impact of an individual benefit, as many members receive multiple services. And it takes time to realize the health consequences.

De Los Santos meals will end soon. She declined an extension, saying she had learned enough about portions and self-control. She feels confident to continue her healthy diet with the help of her husband, who will cook for her.

“My husband tells me to slow down,” she said, “but I have so much more energy.”

Fonseca fears that a life of poor nutrition combined with a physically demanding job has taken its toll on her body. He used to work two fields in one day and travel depending on the harvest season. He never took time off. “Now all I have is time,” he said, “but dialysis is wearing me out.”

He asked his nurse to get medically appropriate meals.

“He must be in good health to be put on a waiting list for a kidney transplant,” his daughter said. “That’s our hope.”

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism on health issues. Along with policy analysis and polling, KHN is one of the three main operating programs of KFF (Kaiser Family Foundation). KFF is an endowed non-profit organization providing information on health issues to the nation. Black Voice News is a distribution partner of Kaiser Health News.

Leave a Reply

%d bloggers like this: