HR-8390-119
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Agriculture, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Sponsored by Raul Ruiz (D-CA)
What it does
This bill would create a federal grant program allowing states to establish or expand "Food as Medicine" programs through Medicaid Section 1115 waivers, providing medically prescribed food and nutrition interventions — such as produce prescriptions, tailored meals, and nutrition counseling — to eligible Medicaid enrollees with chronic conditions or food insecurity. It would also direct the USDA to enter into cooperative agreements with land-grant universities, food hubs, and Regional Food Business Centers to provide technical assistance connecting local farmers to healthcare providers. Additionally, HHS would be required to issue guidance and best-practice recommendations to states within one year of enactment.
Who benefits
Medicaid enrollees with nutrition-related chronic conditions (e.g., diabetes, heart disease, obesity) who would gain access to medically prescribed food. Low-income individuals experiencing food or nutrition insecurity. Local and regional farmers — especially beginning, socially disadvantaged, organic, and regenerative producers — who would gain new institutional buyers. Food hubs and community-based food distribution organizations. Federally Qualified Health Centers and community health clinics. Land-grant universities receiving cooperative agreement funding. Rural and urban communities with limited healthy food access. Registered dietitian nutritionists and health coaches who would provide billable services.
Who is hurt
Conventional (non-organic, non-regenerative) large-scale agricultural producers who may be disadvantaged by the bill's procurement preferences for organic and regeneratively grown products. Medicaid managed care organizations that could face new administrative and cost burdens from implementing food-based interventions. States that do not receive grants but must still respond to HHS guidance. Taxpayers who would bear the cost of the grant program (no appropriations amount is specified in the bill). Pharmaceutical manufacturers whose products may see reduced utilization if food interventions prove effective at managing chronic conditions.
Supporters argue
Supporters argue that diet-related chronic diseases — including type 2 diabetes, hypertension, and heart disease — account for roughly 80% of U.S. healthcare spending, and that food-based interventions have demonstrated measurable clinical results in pilot programs. They contend that the bill addresses both healthcare costs and food insecurity simultaneously, targeting Medicaid populations who bear a disproportionate burden of nutrition-related illness, and that the Section 1115 waiver structure preserves state flexibility rather than imposing a federal mandate.
Opponents argue
Opponents argue that the bill's procurement preferences for organically and regeneratively produced foods — which typically cost significantly more than conventionally grown alternatives — could reduce the number of Medicaid enrollees served per dollar spent, undermining the program's reach. They contend that the evidence base for "Food as Medicine" interventions at scale remains limited and heterogeneous, and that directing federal Medicaid funds toward specific agricultural production methods conflates healthcare policy with agricultural subsidy in ways that may not survive cost-effectiveness scrutiny.
Constitutional context
Congress's authority to fund this program rests on the Taxing and Spending Clause (Art. I, §8, cl. 1), which permits conditional grants to states. However, NFIB v. Sebelius (2012) established that Spending Clause conditions cannot be so coercive as to leave states no genuine choice; because this bill uses competitive grants rather than threatening existing Medicaid funding, it is unlikely to raise a coercion problem. Post-Loper Bright (2024), HHS guidance issued under Section 5 would face independent judicial review rather than automatic deference, meaning courts would assess whether the agency's interpretations are consistent with the statute.
Checks and balances
The Executive Branch (HHS and USDA) gains new grant-making and guidance authority; Congress retains oversight through the required report, the public comment requirement on guidance, and its appropriations power, since no funding amount is specified in the bill itself.
Historical precedent
Several states have run Section 1115 Medicaid waiver pilots for food-based interventions — including California's CalAIM program — but no prior federal statute has created a dedicated national grant program specifically for Food as Medicine interventions under Medicaid.