Food as medicine faces reimbursement and trust hurdles

The system is the bottleneck

Food as medicine is no longer just a product story. The real test is whether a meal, a grocery benefit or a protein-enriched intervention can survive contact with reimbursement rules, local skepticism and the messy realities of care delivery. That is where the gap lives: nutrition science can show promise, but without payer pathways, community trust and long-term funding, promising pilots stay small.

For the protein business, that matters more than it may seem. Protein-rich foods are increasingly being framed as tools for aging, satiety, strength and chronic-disease support, but those claims only matter in the settings where patients actually eat, clinicians actually prescribe and insurers actually pay.

The policy framework already exists

The infrastructure problem is not that nothing has been written into policy. The Centers for Medicare & Medicaid Services said in 2022 that states may use Medicaid managed care “in lieu of services and settings” to provide medically appropriate, cost-effective tailored meals for people with severe chronic conditions made worse by poor diet or food deserts. CMS also says states can pilot nutrition supports through Section 1115 Medicaid demonstration waivers.

That is a real opening, but it is only an opening. Medicaid covers 83 million low-income children and adults in the United States, according to KFF, which means the potential reach is enormous if states, managed-care plans and local delivery systems can line up. The catch is that the policy path depends on state politics, contracting decisions and the capacity of providers on the ground, not just on the strength of the nutrition case.

Trust is built locally, not in a slide deck

This is where the food-as-medicine conversation usually gets too abstract. In real life, these programs depend on whether a neighbor trusts the meal, whether the food fits the culture of the household and whether the delivery network can show up every week. That is why community-based providers matter so much, and why the movement keeps running into the same problem: a product launch is not the same thing as a care model.

Meals on Wheels America has been pushing that point hard. Its 2025 and 2026 advocacy agendas call for home-delivered meals through community-based providers to become a fully reimbursable benefit in fee-for-service Medicare, Medicare Advantage and Medicaid. In its 2023 membership impact report, 97% of members said there were unserved seniors in their communities, and 99% said they were facing challenges serving all seniors who need meals. The list of pain points was brutally practical: lack of funding, high food and gas prices, and difficulty recruiting and retaining staff and volunteers.

That is the part brands and policymakers often underestimate. You can have the cleanest nutrition science in the world, but if the local nonprofit cannot afford the gas to get the meal to the door, the intervention does not scale.

The evidence is encouraging, but the delivery model still has to work

The movement has earned its momentum. A 2024 PubMed review found that Food is Medicine programs, including medically tailored meals, medically tailored groceries and produce prescriptions, have lowered food insecurity, improved health management and reduced healthcare costs. CMS’s VBID Health Equity Incubation Program says there is strong evidence that access to healthy food can significantly lower utilization and costs and produce a return on investment.

That is exactly why the industry is so interested. But the more serious question is not whether food can help. It is whether the intervention can be tailored, financed and sustained well enough to matter in a real clinical workflow. CMS also notes that the Dietary Guidelines Framework can be customized to meet cultural needs, which is crucial because the evidence base is not culturally neutral. Research on medically tailored meals has found that qualitative data can reveal cultural and linguistic barriers affecting acceptability, and that anticipated effects may vary among Latinx and Spanish-speaking participants.

That is not a footnote. It is the difference between a benefit people use and a benefit people ignore.

The summit circuit shows growing momentum

This is moving from concept to care delivery, but slowly. The U.S. Department of Health and Human Services held its inaugural Food is Medicine Summit on January 31, 2024, and Meals on Wheels America said it was there to advocate for seniors. Kaiser Permanente later said the 2026 Colorado Food Is Medicine Summit drew more than 300 attendees, up from about 200 at the first summit in 2023.

Those numbers matter because they show coalition-building. Kaiser said it is funding research, creating community partnerships and developing a Food Is Medicine Center of Excellence, which is a sign that major health systems are starting to treat food access as part of population health strategy rather than a side program. That is the sort of institutional commitment the field needs if it wants to move beyond scattered pilot projects.

Protein has to prove itself in care settings, not just on packaging

For protein, the implication is straightforward. The strongest opportunity is not broad wellness branding, it is clinical usefulness. Recent studies in 2025 and 2026 continue to reinforce that protein adequacy matters for older adults, and that personalized advice or protein-enriched foods can raise protein intake in community-dwelling older adults with low habitual intake.

That matters because many food-as-medicine programs are aimed at people who are older, frailer or at risk of malnutrition, and protein is one of the few nutrition levers that can be tied directly to practical outcomes like maintaining strength, preserving function and supporting recovery. In that setting, protein is not a marketing slogan. It is a tool that can fit into meal plans for vulnerable populations, especially when the goal is to reduce the risk of sarcopenia, support satiety or help older adults meet basic nutritional needs.

But the lesson for the protein industry is bigger than one ingredient category. The future belongs to brands and suppliers that can think past the package and into the system. That means distribution that works in community settings, pricing that can survive reimbursement constraints, and outcomes that payers and providers can actually measure.

The next stage is infrastructure, not hype

Food as medicine is entering a more mature phase, and maturity is usually where the easy stories fall apart. Nutrition science is important, but it will not carry the field on its own. The durable winners will be the programs that can secure reimbursement, earn local trust, adapt to cultural reality and stay funded long enough to prove they work.

For protein-rich foods, that is the opportunity and the warning. The category is well placed to serve real clinical needs, but only if the system around it is built to hold the weight.