How States Are Using the RHTP to Advance Food Is Medicine Interventions

Jamila McLean, State Health and Value Strategies

The Rural Health Transformation Program (RHTP) offers states a unique opportunity to invest federal resources in strategies that address not only medical care, but also the social drivers that shape health outcomes in rural communities. A core strategic goal of the program is to “Make Rural America Healthy Again” by supporting rural health innovations and expanding access points that promote prevention and tackle the root causes of disease.

One highly effective intervention that has emerged across multiple state applications is “Food Is Medicine” (FIM). The U.S. Department of Health and Human Services (HHS) defines Food Is Medicine as a “broad range of approaches that promote optimal health and healing and reduce disease burden by providing nutritious food—in conjunction with human services, education, and policy changes—through collaboration at the nexus of health care and community.”

The FIM framework recognizes that access to nutritious food is foundational to health, resilience, and wellbeing and is shaped by five guiding principles: that nourishment is essential for good health; that communities should have easy access to healthy food across the health continuum; that individuals should understand the connection between nutrition and health; that cross-sector partnerships are necessary to build sustainable solutions; and that investments must strengthen the capacity of under-resourced communities.

State Medicaid agencies are increasingly formalizing FIM interventions by leveraging policy options such as section 1115 demonstration pilots, value-added benefits & in-lieu-of services (ILOS), and home and community-based services (HCBS). FIM interventions can vary in scope, combining direct food provision with nutrition counseling and education or solely focusing on one or the other. Common evidence-based models deployed through FIM programs include medically tailored meals and groceries, medically supportive meals, produce prescriptions, and nutrition incentive programs.

This expert perspective highlights select state initiatives and activities that propose leveraging the RHTP to advance FIM and other food and nutrition interventions. 

Examples of Proposed State Efforts to implement Food Is Medicine Initiatives

• Delaware’s RHTP plan proposes establishing a FIM infrastructure in Kent and Sussex counties. The state is currently soliciting proposals to support implementation of the initiative, which aims to address the high prevalence of diet-sensitive conditions, including diabetes, hypertension, and chronic kidney disease, while reducing healthcare costs and advancing health equity. The request for proposal goals include expanding access to FIM services, improving health outcomes, strengthening workforce capacity and cross-sector partnerships, and building a sustainable, replicable infrastructure that can support long-term implementation.

• Kansas’ RHTP application proposes the Accountable Food Is Medicine + CHW Deployment Program, which will integrate community health workers (CHWs) into efforts to expand access to nutrition-based supports. Through the program, CHWs will be trained by the Care Collaborative to identify individuals eligible for FIM services, recruit participants, and provide resource navigation such as connecting individuals to healthy food options and enrolling them in nutrition courses. CHWs will also engage local families in early childhood healthy eating and physical activity by leading community workshops, hosting cooking demonstrations, and distributing family-focused educational resources.

• Maryland’s RHTP application proposes the Empower Rural Marylanders to Eat for Health initiative, which focuses on strengthening rural food access and nutrition supports. The initiative includes investments in cold storage infrastructure such as freezers, refrigerators, and lockers to reduce post-harvest spoilage and help small farms reliably supply local markets. Funding will also be used to expand the NourishMD: Healthy Food Access Grant Program providing capital for small grocers and mobile markets in identified hunger hotspots to support equipment purchases, facility improvements, and technology for retailers committed to stocking fresh proteins, produce, and dairy. In addition, funding will support local health departments in delivering targeted nutrition education within rural communities.

• Nebraska’s RHTP application proposes the “Make Rural Nebraska Healthy Again Through Food as Medicine” initiative, which focuses on building sustainable community-based infrastructure to expand access to nutritious foods. The initiative emphasizes partnerships and enhanced training models that embed expertise within communities, including a train-the-trainer approach that equips University of Nebraska–Lincoln Extension professionals, food service directors, and culinary experts to support healthy menu design and mentor new cohorts over time. The strategy also includes strengthening regional food hubs to help farmers and ranchers sell products locally and expand access to nutritious foods. State agencies, including the Nebraska Departments of Agriculture and Economic Development, will provide ongoing technical assistance and support farm-to-school procurement and policy efforts to help ensure the long-term sustainability of Food Is Medicine initiatives beyond the initial RHTP funding period.

• North Carolina’s RHTP application proposes leveraging NC ROOTS Hubs to advance the Healthy Foods and Healthy Families priority within the state’s Make Our Children Healthy Again The proposed Food Is Medicine proposal focuses on building partnerships and infrastructure to connect patients and families with nutrition supports such as healthy food boxes, medically tailored meals, and nutrition education delivered through community-based organizations (CBOs) including food pantries, clinics, and YMCAs. The strategy also includes investing in local food infrastructure; supporting farmers and community food banks; expanding mobile food markets; and increasing access to farmers market Supplemental Nutrition Assistance Program (SNAP) and Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) matching programs such as Double Bucks and farm-to-hospital initiatives. In addition, the plan proposes implementing electronic referral and tracking systems and expanding the capacity of CBOs and CHWs to provide evidence-based nutrition education on food preparation, budgeting, and making healthy choices regardless of budget or location.

• Pennsylvania’s RHTP application proposes establishing Community Wellness Hubs to improve health and strengthen collaboration between healthcare and community resources. Rooted in trusted local organizations and supported by statewide infrastructure, these hubs will coordinate access to wellness activities, social supports, and healthier living resources close to home. The hubs are also designed to support Food Is Medicine infrastructure by connecting individuals to fresh food programs, produce prescription initiatives, and local food providers in partnership with healthcare providers, public health centers, and insurers.

• Virginia’s RHTP application proposes the “Live Well, Together” initiative, which focuses on preventing chronic disease through community-based, whole-health sub-initiatives. The Food is Medicine component will support the infrastructure and start-up costs for food pharmacy programs led by health systems and rural providers in partnership with CBOs. These partnerships are designed to support sustainability through clinically integrated food provision, nutrition education, and disease self-management support. RHTP funding will support infrastructure development, distribution networks, and technology for patient tracking, with opportunities to partner with digital health firms such as RxDiet to provide remote nutrition support.