by Sejal Parekh
Recipe 4 Health participants have seen impressive results, including reduced chronic disease indicators, and AB 1975 would ensure permanent funding for the program.
Elizabeth Duran had knee surgery in 2021, which limited her physical activity and caused her to gain weight. Duran, 65, took high blood pressure medication and dealt with anxiety privately.
In the fall of 2023, her doctor introduced her to Recipes 4 Health, a county program that delivers fresh produce to her home. Duran, who is Hispanic, credits the program with helping her get her life back on track.
“I was aware of Swiss chard and kale, but I’d never really chosen them,” Duran says. After learning about their nutritional value on the show, she researched ways to prepare them.
Duran said participating in Recipe 4 Health has helped her control her blood pressure, improve the quality of her sleep and reduce her anxiety.
Since its launch in 2020, Recipe 4 Health, part of the Food Is Medicine initiative, has connected more than 6,000 Alameda residents – 83% of whom are people of color and more than half are Spanish speakers – to healthy vegetable options and wellness coaching. The results have been impressive.
“One-third of patients with prediabetes and diabetes experience a clinically meaningful reduction in their blood sugar levels,” notes Dr. Steven Chen, the program’s chief medical officer. “Two-thirds of patients experience improved cholesterol indicators and reduced risk of heart disease,” and “44 percent of patients experience a reduction in their depression symptoms.”
These outcomes help prevent chronic and cardiovascular diseases and ultimately save money on health care, said Chen, who believes continued funding for Recipes4Health is essential to the program’s long-term viability.
Currently, Recipe 4 Health receives the majority of its funding from CalAIM, a multi-year initiative that combines federal and state funds to address social determinants of health, including food and housing insecurity.
The Department of State Health Services (DHCS) administers CalAIM and provides funding to local Medi-Cal plans to reimburse programs such as Recipe 4 Health, which provide medically supported nutrition.
DHCS was granted a five-year extension of CalAIM’s federal funding, which was set to expire in December 2021. As 2026 approaches, Chen is looking for a stable source of funding for the program that doesn’t require frequent renewals.
That’s why he’s urging lawmakers to pass AB 1975, a second attempt by Rep. Mia Bonta (D-Oakland) to require Medicaid coverage of the Assisted Meal Program. If passed, California would be the first state in the nation to require the Medicaid program to cover the benefit. The bill is currently before the state Assembly.
“Too many Californians, especially residents of color, live with preventable chronic diseases and conditions,” Bonta said, noting that her measures would go a long way toward improving health equity in the state.
The majority of people enrolled in Recipe 4 Health are low-income people of color.
Sasha Shankar, co-farm manager at Dig Deep Farms, which supplies produce for the program, said program participants receive 16 meals of fresh fruits and vegetables every week for three months.
Meanwhile, weekly health coaching helps participants learn about nutrition, exercise and stress management, as well as helping them set and achieve health goals.
To participate in Recipe 4 Health, Medi-Cal patients in Alameda County need a referral from their primary care physician at a participating health center, which includes Alameda Health System, Bay Area Community Health, Lifelong Medical Care, Native American Health Center and Tiburcio Vasquez Health Center.
The program is separate from CalFresh, California’s food stamp program, and many patients can receive both Recipe 4 Health and CalFresh benefits at the same time.
Primary care providers can refer patients if they are food insecure or have a chronic illness such as diabetes, high blood pressure, high cholesterol, heart failure or stroke.
Of Alameda’s 1.6 million residents, about 10% (about 154,000 people) live in food insecure households.
Once participants are referred by their primary care physician, Recipe 4 Health receives the referral and passes it on to the county’s Medi-Cal plan, Alameda Alliance for Health, for approval. Referrals are also forwarded to our partners, Dig Deep Farms and Open Source Wellness, who provide health coaching. These partners contact participants to verify their contact information before beginning services.
But despite the program’s success, it hasn’t been without challenges. “Just a few weeks into the program, the pandemic hit,” Chen says. “We switched completely to doorstep deliveries, and then we moved to virtual groups.”
The pandemic has had some ripple effects on the program: Fewer people are seeing their primary care physicians for routine care, so referrals to Recipe 4 Health have also decreased.
Contact information in clinics’ medical records also became out of date. If phone numbers weren’t updated in clinic records, referrals would pass along incorrect information to Recipes 4 Health. When that happens, “we have data that shows that rate drops substantially,” by up to 50 percent. “If the number is wrong, we can’t reach the patient, and they’re kind of stuck,” Chen says.
Lack of time or transportation may prevent participants from attending weekly coaching sessions. In 2023, only 1,105 of the 1,949 Recipe 4 Health participants (about 56%) attended coaching.
That’s putting a strain on open source, Director Elizabeth Markle explained, and Recipe4Health is now trying to renegotiate its contract with the organization by moving to a fee-for-service model.
Inflation and rising food costs are also playing a role. Shankar said Dig Deep Farms was reimbursed $23 for every bag of produce delivered to participants in 2023, and will have to increase its reimbursement rate in 2024.
But compared to the billions of dollars California spends annually on treating chronic diseases, Recipe4Health’s per-patient spending — about $785 per participant per year, based on information provided by Chen’s team — is more cost-effective.
When critics ask, “How are we going to pay for this food?” Chen responds, “We’re already paying for it. We’re just paying for it through the health care system.”
Dr. Sejal Parekh is a paediatrician. Stanford Health Equity Media Fellow.
Provided by: Ethnic Media Services
