Cook County, Illinois, recognizes the importance of a holistic approach to health care and is expanding access to healthy food and nutrition services to Medicaid enrollees through the FoodCare initiative.
FoodCare is a program within the Cook County Health Department's CountyCare Plan, which helps connect Medicaid recipients with housing, transportation and food. Of the roughly 430,000 people in Cook County served by CountyCare, at least 6 percent are food insecure, according to health risk screening. But that number is probably much higher, with estimates as high as 50 percent, because food insecurity is under-reported, according to Aaron Galliner, chief administrative officer for health insurance services at the Cook County Health Department.
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The FoodCare Initiative of Cook County, Illinois, received a 2024 NACo Achievement Award in the Health category.
“It's hard to take care of your asthma or diabetes when all you're thinking about is where your next meal is coming from,” Gallinar said, “so we've developed programs aimed at addressing some of the other needs our members have and trying to help them take better control of their health.”
FoodCare works to improve health equity and food access through three programs.
• Emergency home-delivered meals to Medicaid recipients who have recently been discharged from a hospital stay or who have been identified by their care coordinator or dietitian as being food insecure.
• The FoodCare interactive digital platform connects Medicaid members with a dedicated registered dietitian, allows unlimited dietitian visits and helps with meal planning, shopping on a budget and food delivery.
• Medically tailored meals for Medicaid enrollees with certain medical conditions and for pregnant enrollees with gestational diabetes or hypertension.
According to Cook County Health Department data, more than 13,000 meals have been delivered through FoodCare, more than 43,000 people have enrolled in nutrition programs with dietitians, and about 1,400 Medicaid recipients have also enrolled in the medically coordinated meal program.
“We know that nutrition underlies many important chronic diseases, including diabetes, obesity and gestational diabetes during pregnancy,” Gallinar said. “So we started by asking, 'What are the health outcomes we want to impact?' and, 'What are the key needs or challenges we want to address?'”
For example, when a diabetic joins FoodCare, they have access to a dietitian who can guide them on the food choices that will best help them manage their diabetes. Those foods are then delivered through a medically tailored diet program, such as low-glycemic index and high-protein foods, according to Galliner.
Foodsmart, a nutrition organization with the nation's largest network of registered dietitians, has partnered with Cook County Health on FoodCare. Foodsmart provides nutrition education through an online platform for Medicaid enrollees and will pay a $50 grocery bill after completing an initial dietitian consultation and $15 for each follow-up visit.
“There are some things they can offer right away that we wouldn't have if we were trying to create something entirely new,” Gallinar said, “and we wanted to make sure we could scale the program to the appropriate level.”
CountyCare also partners with local businesses to prepare meals that are delivered through FoodCare, many of which are women- and minority-owned, according to Galliner. Meals are primarily delivered, with the exception of emergency meals, which are often delivered by care coordinators. Galliner said emergency meals are distributed when someone is in urgent need of food or is housing unstable and there is no obvious place to mail food.
According to data from the Cook County Health Department, about a year and a half after FoodCare launched, 56% of obese users have lost weight (an average of 9 pounds) and 66% of enrollees have seen an improvement in their Nutri-Score, a nutritional rating system that balances “plus” points for healthy foods like protein, fruits, vegetables, nuts and fiber with “minus” points for foods high in salt, saturated fat and sugar.
“We're already seeing great results in terms of weight loss and improved diabetes control, all of which translates into long-term cost savings,” Gallinar says, “so there are likely benefits to investing in these programs.”
Cook County Health receives about $600 per month from the state of Illinois for each Medicaid enrollee (amounts vary by age and gender). That $600 goes toward health plans, utilization, administrative fees and programs like FoodCare. Cook County Health created programs like FoodCare to not only better serve Medicaid enrollees, but also to lower an individual's health care costs over the long term as their health improves, Galliner said.
“We're serving a population that is medically underserved,” Galliner said, “and that's right in line with the history of the Cook County Health Department, which has been serving this population for almost 200 years. We know that beyond the general health issues that people face, many of the major contributing factors that are linked to health care are these other social risk factors.”
