Opinion | Why Michigan must protect Medicaid program that promotes healthy food

“An apple a day keeps the doctor away.” Yet only about 1 in 10 Michiganders eats enough fruits and vegetables per day. As physicians and health services researchers focused on the impact of nutrition and nutrition policies on health outcomes, we frequently see the impact of poor nutrition on our patients. Poor nutrition affects health at all ages and increases the risk for costly chronic diseases.

In our current medical system, we often wait until people are sick to provide expensive health care, rather than keeping people healthy. A growing acknowledgment that “food is medicine” hopes to flip this script in health care. In 2025, Michigan Medicaid will implement a new program called In Lieu of Services (ILOS), which allows Medicaid to pay for food and nutrition services that improve health. Recently, lawmakers have threatened significant federal Medicaid spending cuts — which could jeopardize this program and its significant potential cost savings for chronic disease management.

Unfortunately, Michigan has some of the highest rates of diet-sensitive chronic conditions such as diabetes, high blood pressure, and heart disease in the US. Poor nutrition is a primary driver of these high rates of chronic disease. Adult Michiganders only eat the recommended amount of fruit 12% of the time and vegetables 7% of the time. Eating healthy is even harder for those without consistent access to affordable nutritious foods. 

Programs like ILOS improve fruit and vegetable intake and overall health for children and adults. The ILOS program is customizable to the medical needs of the patient or family, including options for 1) fruit and vegetable prescriptions, 2) healthy food packs, 3) medically tailored groceries, or 4) medically tailored meals. Michigan will be among the first states to implement this program, and the first in the Midwest.

Despite the promise of ILOS, federal officials’ threats to cut Medicaid spending could jeopardize the ILOS program. Cuts to this program are shortsighted given the ILOS programs’ potential to reduce health care spending. Michigan’s annual statewide health care costs associated with inconsistent access to affordable nutritious food are already in the top 25% in the nation. Helping people eat healthier can actually reduce health care costs. 

A 2022 study estimated that if all Americans with diet-sensitive conditions received medically tailored meals, the US would save more than $13 billion annually in health care costs. While addressing these health care costs, the ILOS program can simultaneously strengthen Michigan’s food and agricultural economy by supporting local Michigan businesses. Michigan agriculture already contributes more than $100 billion annually to our state’s economy, and this figure may grow with the new ILOS program.  

The new Michigan Medicaid ILOS program invests in the health of communities across the state of Michigan. We commend the Michigan Department of Health and Human Services for championing this work, and hope for fruitful collaboration across health care, grocery, and agricultural sectors to ensure program success. 

To improve the health outcomes and health care costs for Michiganders, we must protect this critical program from threatened Medicaid spending cuts. We are hopeful that this program will mark a new era in health care in Michigan.