(P20-090-24) Integrating Food Security Solutions Into the Healthcare System

Objectives: In 2018, Massachusetts used the 1115 waiver to gain approval from the Centers to Medicaid and Medicare to utilize Medicaid dollars to address social determinants of health, such as housing and nutrition. Under the 1115 federal waiver, Project Bread, a Massachusetts-based organization, developed a unique model through its state’s flexible services program. Our objective was to evaluate the effectiveness of Project Bread’s model, with changes in food insecurity, nutrition knowledge, and Supplemental Nutrition Assistance Program (SNAP) enrollment as the primary outcomes of interest.

Methods: This was a mixed-methods study to evaluate the effectiveness of Project Bread’s model, which has enrolled over 12,000 clients to date. Patients who screen positive for food insecurity and have a complex behavioral and/or medical condition may be eligible to participate in Project Bread’s program. Once in the program, clients receive tailored nutrition services such as grocery store gift cards, kitchen supplies, nutrition counseling, and support in enrolling in SNAP. Key informant interviews were conducted with Community Health Workers (N = 16). Focus groups were conducted with former flexible services program clients (N = 8). Quantitative data was collected though phone surveys with former flexible service program clients (N = 212). Quantitative data was appended to longitudinal programmatic data to measure changes in primary outcomes over a 15-month period. Primary outcomes were measured at baseline, during program implementation, and six-month post-program.

Results: Program data show a 24.2% decrease in food insecurity in clients between baseline and the end of the program (p < 0.001). Qualitative interviews found acceptance of the program. Six-month post-program quantitative data show a regression in food security status but sustained program benefits in nutrition knowledge and SNAP enrollment.

Conclusions: Project Bread’s flexible services program model is effective in reducing food insecurity and can serve as an example for other community-based organizations and states implementing flexible service programs. Post-program regressions in food insecurity underscore the need to develop methods to sustain programmatic benefits.

Funding Sources: Dana-Farber Cancer Institute