Food Security in Texas Medicaid
In 2025, Texas took a landmark step toward addressing the food security and health needs of Medicaid members with the passage of House Bill 26 (HB 26). This legislation marked a pivotal shift in how the state approaches health, which recognizes that food and nutrition are essential components of well-being and prevention, not just add-ons to medical care.
HB 26 authorized the use of the “In Lieu of Services” (ILOS) policy tool within Texas Medicaid. For the first time, Medicaid health plans will be allowed to cover non-traditional, health-related services, such as nutrition counseling and pilot medically tailored meals for pregnant Texans with chronic conditions, when these services are clinically appropriate and cost-effective.
This innovative approach enables Medicaid Managed Care Organizations (MCOs) to address food insecurity directly, supporting members’ health in ways that go beyond the doctor’s office.
The passage of HB 26 reflects growing momentum among Texas policymakers, philanthropic organizations, and health advocates to invest in prevention and address non-medical drivers of health. It reflects years of advocacy and strategic partnership among numerous stakeholders who have championed the integration of nutrition support into Medicaid benefits.
As Texas implements HB 26, very little is known about Value-Added Services (VAS) that are currently being offered to Medicaid members to meet members’ food and nutrition needs. Most of the communications about VAS benefits are being listed on MCO websites or outreach materials. Very little is being written about, evaluated, or shared publicly. We decided to take a deep dive to summarize and highlight the range of food-related VAS currently available, illustrating how policy change is translating into real-world support for Texans.
What Are Value-Added Services (VAS)?
VAS are optional benefits that go beyond standard Medicaid services. They are intended to promote healthy lifestyles, address non-medical drivers of health, and improve quality measures.
- Examples: Wellness programs, additional transportation, vision or dental services, and food and nutrition support.
- Funding: MCOs pay for VAS using their own budgets and funds, not Medicaid program dollars.
- Utilization: Historically, VAS utilization has been low, often due to lack of awareness among members.
Types of Food-Related VAS Offered
Across Texas Medicaid MCOs, food-related VAS generally fall into several categories:
- Meal Delivery: Many plans offer home-delivered meals, especially after hospital discharge, for postpartum members, or for those with chronic conditions.
- Nutrition Counseling & Education: Some MCOs provide access to nutritionists, dietitians, or structured counseling programs.
- Transportation to Food Resources: Several plans offer rides or bus passes to WIC offices, food banks, grocery stores, or community events.
- Grocery/Food Incentives: Gift cards, grocery delivery memberships, or allowances for healthy food purchases are available in select plans.
- Emergency or Flexible Food Support: A few MCOs provide emergency food delivery or flexible benefits for members facing significant life events.
Breadth and Depth of Offerings: Plans and Benefits
Some MCOs (e.g., Community Health Choice, Wellpoint, Driscoll Health Plan) combine multiple types of VAS, such as meal delivery, transportation, and nutrition counseling, offering a holistic approach to food security. Other plans focus on specific populations, such as pregnant women, high-risk members, or those recently discharged from the hospital (e.g., Cook Children’s Health Plan, El Paso Health).
Geographic and Program Variation
The availability and scope of VAS often depend on the service area. For example, some benefits are only available in urban counties or specific regions.
- Program-Specific Benefits: STAR, STAR+PLUS, and STAR Kids programs each have tailored VAS, with some plans offering more robust benefits in one program than another.
Innovation and Unique Approaches
- Grocery Delivery Memberships: Driscoll Health Plan’s one-year SHIPT grocery delivery for high-risk pregnant members stands out as an innovative approach.
- Flexible Benefit Choices: Wellpoint allows eligible members to choose between produce boxes, warehouse club memberships, or a healthy grocery gift card.
- Gas Rewards: Molina and El Paso Health offer gas cards to help members reach food resources, addressing transportation barriers in a unique way.
Gaps and Opportunities
- Low Awareness and Utilization: Despite the range of offerings, utilization remains low, often due to lack of member awareness or understanding of how to access these services.
- Variation in Availability: Not all MCOs offer food-related VAS, and the scope can vary widely, resulting in varying levels of access based on plan and location.
- Potential for Expansion: With the policy momentum from HB 26, there is an opportunity for more plans to expand or innovate their food-related programs, especially as Medicaid policy evolves to support non-medical drivers of health.
Additional Medicaid Nutrition Programs
In addition to offering nutrition services through VAS, MCOs also offer services through other programs including:
- Offering medically tailored meals for individuals with chronic conditions as part of disease management or value-added service.
- Food assistance or nutritional counseling as part of a larger quality improvement program for a targeted population.
- Assisting older adults and adults with disabilities on a home and community-based services waiver to access home delivered meals.
- Screening members for medical and non-medical needs, including food insecurity, and connect at-risk members with health plan Service Coordinators who can ensure appropriate access to covered and non-covered services, including nutritional or food assistance.
- Giving donations or grants to food banks and other community-based organizations.
Conclusion
Texas Medicaid MCOs are increasingly addressing food insecurity through a variety of VAS, but the scope, innovation, and accessibility of these services vary widely. We hope to create opportunities for MCOs to share and highlight their best practices, challenges and lessons learned in implementing these VAS benefits and other food programs at the upcoming Texas MCO NMDOH Learning Collaborative. EHF will engage MCOs as well as their partners in learning about their experience in implementing these VAS benefits and other food related programs.
We hope the MCOs’ experiences will offer valuable insights to HHSC and MCOs in implementing HB 26 in the coming years. The passage of HB 26 creates momentum for more consistent, comprehensive, and innovative food-related benefits across the state. Continued evaluation and sharing of best practices can help ensure all Medicaid members benefit from these critical supports.
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