This assembly bill was introduced by Assembly Member Bonta on February 17, 2023. The current legislation establishes the Medi-Cal program, which is overseen by the State Department of Health Care Services. This program provides health care services to eligible low-income individuals, with its operations influenced and funded in part by federal Medicaid program provisions. The law mandates the department to institute both the Medically Tailored Meals Pilot Program and the Short-Term Medically Tailored Meals Intervention Services Program. These programs are designed to operate in specific counties and for limited durations, aiming to offer medically tailored meal intervention services to qualifying Medi-Cal beneficiaries facing particular health conditions such as congestive heart failure, cancer, diabetes, chronic obstructive pulmonary disease, or renal disease. Contingent upon the implementation of the California Advancing and Innovating Medi-Cal (CalAIM) initiative, the law allows a Medi-Cal managed care plan to choose to cover community supports, endorsed by the department as cost-effective and medically suitable, in a comprehensive risk contract instead of the applicable Medi-Cal state plan services. Among the community supports that the department is authorized to approve are medically supportive food and nutrition services, including medically tailored meals.
This legislation aims to designate medically supportive food and nutrition interventions, as defined, as a covered benefit within the Medi-Cal program, contingent upon the issuance of conclusive guidance by the department. The bill mandates that coverage for medically supportive food and nutrition interventions is dependent on a determination of medical necessity by a health care provider or health care plan, as outlined. To be eligible for Medi-Cal coverage, the patient must be offered a minimum of 3 out of 6 specified medically supportive food and nutrition interventions, provided for at least 12 weeks. The bill exclusively grants coverage for nutrition support interventions when coupled with the supply of food through one of the offered interventions. It further necessitates that health care providers align the intensity and duration of medically supportive food and nutrition interventions with the acuity of a patient's condition, incorporating culturally appropriate foods whenever feasible. The legislation establishes a Medically Supportive Food and Nutrition Benefit Committee, or a medically supportive food and nutrition benefit advisory workgroup, to aid the department in formulating conclusive guidance regarding eligible populations, duration and dosage of interventions, the rate-setting process, determination of permitted providers, and continuing education for health care providers, as specified. The committee or workgroup is required to convene at least quarterly, and the department must issue final guidance by July 1, 2026. The bill also includes legislative findings and declarations regarding the necessity of coverage for medically supportive food and nutrition interventions under the Medi-Cal program.