Reshaping Food as Medicine: New Insights from Federal and State Policymakers
FaM—short for Food as Medicine, Virtual Food Care, and/or Food as Health—is rapidly reshaping healthcare by shifting the focus from pharmaceutical interventions to nutrition-based prevention and disease management. FaM stakeholders include provider networks, health plans, digital health companies, grocers, retailers, food distributors, community-based organizations (CBOs), and nonprofits. Core services range from medical nutrition therapy (MNT) and nutrition counseling—often delivered via telehealth—to medically tailored meals (MTMs), food prescriptions, food boxes, and medically tailored groceries, many of which are available via remote delivery.
As FaM continues to evolve, it presents new opportunities for innovation, along with important legal and regulatory considerations. Below, we highlight key federal and state developments shaping the FaM landscape in the second half of 2025 and into 2026.
Federal Considerations
January 2025 marked the beginning of a new presidential administration and a shift in approach to Medicare and Medicaid. At the federal level, there are three main areas to watch: (i) the Make America Healthy Again initiative, (ii) the U.S. Preventive Services Task Force (USPSTF), and (iii) the Medical Nutrition Therapy (MNT) Act.
Make America Healthy Again
Established by executive order, the Make America Healthy Again (MAHA) Initiative created a federal MAHA Commission, which set ambitious goals for addressing chronic disease through nutrition-based interventions. The MAHA Initiative calls for fresh thinking around nutrition, physical activity, healthy lifestyles, over-reliance on medication, environmental impacts, technology habits, and the safety of food and drugs. Under MAHA, federal agencies must expand access to treatment options, support insurance coverage for lifestyle-based prevention measures, and identify and report best practices for preventing childhood health issues through nutrition and healthy habits.
U.S. Preventive Services Task Force
In Kennedy v. Braidwood Management, Inc., the Supreme Court recently upheld (by a 6–3 vote) the Affordable Care Act’s requirement that private insurers cover preventive services recommended by the USPSTF, including cancer screenings, contraception, and HIV PrEP. These services are typically exempt from co-pays and deductibles for both Medicare and private plan beneficiaries. In alignment with the MAHA Initiative, the USPSTF could designate medical nutrition therapy (MNT)—often the entry point for FaM care—as a preventive service, thereby broadening coverage and removing financial barriers for beneficiaries. However, FaM stakeholders will need to provide robust clinical data to support a preventive service designation by the USPSTF.
The Medical Nutrition Therapy Act
Now before Congress, Medical Nutrition Therapy Act could be a game-changer for FaM. If passed, this law would enable all Medicare beneficiaries to receive MNT as a covered service. The proposed legislation aims to (i) expand Medicare coverage for MNT to additional conditions and disease states, (ii) allow a broader array of providers beyond physicians to refer patients for MNT services, and (iii) shift the focus from disease management to chronic disease prevention.
Proposed 2026 Medicare Physician Fee Schedule and Solicitation for Comments
In mid-July 2025, the Centers for Medicare and Medicaid Services (CMS) released the 2026 Proposed Medicare Physician Fee Schedule (MPFS). CMS included a Request for Information (RFI) on how to improve the prevention and management of chronic diseases in the Medicare population. Digital health companies are uniquely positioned to offer scalable, tech-enabled solutions in the FaM space – and all FaM stakeholders should carefully review the portion of the RFI below and consider submitting comments to inform CMS’ perspective.
Should CMS consider creating separate coding and payment for medically-tailored meals, as an incident-to service performed under general supervision of a billing practitioner? If so, what would be the appropriate description of such a service, and under what patient circumstances (that is, after discharge from a hospital)? Do community-based organizations providing medically tailored meals currently employ a physician, nurse practitioner, physician assistant, or other practitioner who could both bill Medicare and supervise a medically-tailored meal service? Should CMS consider allowing billing providers to refer to community-based organizations to deliver and ensure quality of medically-tailored meals while under general supervision (please see § 410.26(a)(3) for further information about general supervision) of the referring billing provider? If CMS were to create separate coding and payment for medically-tailored meals, how should CMS ensure integrity of the service being delivered?
Nixon Law Group is available to assist with drafting and submission of comments. Please contact us for additional information.
State Considerations
Healthcare is regulated extensively at the state level, and FaM is no exception. Medicaid 1115 Waivers, the Corporate Practice of Medicine doctrine (“CPOM”), dietitian licensure compacts, and new state laws are shaping compliance obligations for FaM innovators. These considerations are essential for FaM innovators delivering services via telemedicine or other remote means.
1115 Waivers
Several states use 1115 Waivers to integrate FaM programs into Medicaid. These waivers allow states to (i) fund medically tailored meals for chronic disease management, (ii) expand coverage for food prescription programs, and (iii) implement produce initiatives in underserved communities through CBOs. Many of the benefits are offered through telemedicine. However, innovators face several unique challenges at the state level, including restrictive proposals that require CBOs to hold non-profit status or require states to grant preferential contracting treatment to non-profit CBOs. Moreover, the recently passed federal budget reconciliation bill, H.R. 1 (the “One Big Beautiful Bill Act”), could reduce Medicaid opportunities by increasing eligibility requirements for Medicaid beneficiaries. While there will likely be less funding for future 1115 waivers, existing 1115 Waivers should not be affected.
Corporate Practice Of Medicine
Many states have CPOM laws prohibiting ownership in medical practices by unlicensed individuals and corporations. The CPOM doctrine led to the advent of MSO-PC models that allow for compliant expansions into multiple states. Certain states, such as New York, have specifically included dietitians and nutritionists in their definitions of regulated professions, thus bringing dietitians into the fold of CPOM. This means that FaM companies organized as traditional corporations owned by non-licensed professionals risk severe penalties and enforcement actions in states such as New York, and telemedicine companies in the FaM space are subject to heightened compliance obligations.
Licensure Compacts
States are developing licensure compacts (a “Compact”) to allow dietitians and nutritionists to practice across state lines in response to the growth of FaM services delivered via telehealth. As of this writing, fourteen states (AL, AR, IA, KS, MS, MT, ND, NV, OK, OH, RI, SD, TN, and UT) have signed onto the Compact. The Compact enables telemedicine companies in the space to more seamlessly provide MNT and nutrition counseling across state lines, a crucial operational consideration for telemedicine and remote-first FaM solutions that must account for state-specific licensure requirements.
New State Laws to Expand FaM Coverage
Last year, New York passed a state law that mandated coverage for MNT as a preventive service for Medicaid members. Effective July 1, Oklahoma passed the Food is Medicine Act, which provides Medicaid members with coverage for MNT, MTMs, foodscripts, and groceries. Connecticut and Illinois also have bipartisan bills that would expand Medicaid-covered services for several FaM services as a matter of law.
As federal funding and approvals decrease for 1115 Waivers and SNAP-Ed is defunded, states will likely implement their own funding and legal frameworks to provide coverage for FaM. Given the speed and varying scope of these new laws, it will be critical to understand these additional legal and compliance considerations.
Key Takeaways
Federal Compliance: As reimbursement opportunities grow—through the proposed MNT Act, potential USPSTF preventive service designation, and the CMS RFI on MTMs—FaM stakeholders must stay ahead of evolving federal reimbursement and compliance requirements. This is especially important amid potential Medicaid reimbursement challenges.
State Regulations: National telemedicine FaM models, particularly those involving dietitian networks, face varying state requirements. Structure operations to comply with the most restrictive CPOM laws (e.g., New York, Oregon) and reassess staffing as licensure compacts expand.
Ongoing Oversight: With shifting federal and state frameworks, FaM companies should conduct semi-annual audits of their corporate structure and compliance programs. Staying in close contact with legal and regulatory advisors is critical to ensure alignment with fast-evolving requirements.
Need help navigating the evolving FaM landscape?
With new developments at both the federal and state levels—ranging from HHS–USDA coordination to Medicaid updates and complex health plan arrangements—FaM stakeholders must stay ahead. Whether you’re preparing RFI comments or evaluating how these changes affect your business model, our team can help.
The FaM landscape is becoming increasingly complex with changes occurring at all levels. Whether you have questions about changes at the state or federal level, need guidance on how to partner with health plans, or could use help drafting and submitting comments to the MPFS, we’re here to help.