VICTORVILLE, California – Every Friday, Frances de los Santos waits for a consignment of healthy, ready-to-eat food to descend on his front porch at the edge of the Mozave Desert. From the box, the 80-year-old retired property manager with Stage 4 chronic kidney disease unpacks a frozen food tray that he can heat in the microwave. Her favorite sweet and sour chicken.
Three months after he started eating customized foods, de los Santos learned to manage his diabetes by maintaining a healthy blood sugar level.
Two hours south, in Indio, Vidal Fonseka prepares for his third dialysis appointment of the week. He also fights against kidney disease and diabetes. The 54-year-old former farmer was released from hospital in November with orders to follow a strict diet, but he rioted in the kitchen and struggled to bring his glucose under control. He does not take prepared food.
Here in the vast inner kingdom of California, where more than half of adults have diabetes or are at risk of developing diabetes, a health plan is providing medically appropriate food for selected patients. By bringing food directly to their doorsteps for a few months, state officials hope that patients will develop healthy eating habits long after shipments stop. It is part of a larger state effort to improve the health of some of his sick and expensive patients.
California’s five-year initiative, known as CalAIM, will examine whether Democratic Governor Gavin Newsom can reduce public spending on Medi-Cal, the state’s Medicaid program for low-income people, which has skyrocketed to $ 124 billion this fiscal year, nearly three times as much. More A decade ago. Medi-Cal managed-care insurers will try to keep people away from expensive healthcare facilities by providing social services, such as helping patients find accommodation, removing toxic mold from their homes and providing food prepared by medical care.
CalAIM, which will cost 8.7 billion, is obsolete because it is primarily run by the health plan, not the county social services department. It will serve only one sliver out of the 14.5 million Californians enrolled in Medi-Cale. And the state is still developing a way to track health outcomes, which means no one still knows if it will save money.
“It’s a new program, and often with new programs, you’re building the plane while you’re flying it,” said Shelley Lamaster, Integrated Care Director at Inland Empire Health Plan.
The health plan is one of only two Medi-Cal managed-care insurers providing services in San Bernardino and Riverside Counties, and about 1.5 million are registered. The Inland Empire Health Plan says about 11,000 of its enlisted people will be eligible for food and lunch boxes. The average meal benefit costs 1,596 and lasts three months, although health insurers may choose to increase the food supply.
Because plans determine which enlisted people will receive the service, many eligible patients – even those enrolled in the same plan or living in the same county – are being excluded. In the Inner Empire, some patients have started taking food while others are still being enrolled. So far, 40% of recipients are Hispanic, 35% white, and 18% black, who keep track of the region’s population. (Hispanics can be any race or ethnic group.)
For most participants, the primary delivery will be frozen food, ranging from taco bowls to chicken curry. Later, they can get boxes full of fresh fruits, vegetables, whole grain breads, pasta and rice so they can prepare their own food.
De Los Santos is one of the lucky 720 entrants who have been approved for benefits since January. Participants must be mentioned in the program, but referrals can come from doctors, community groups, and family members – Medi-Cal registrants may even refer themselves.
De Los Santos’s case manager has identified his needs after conducting an assessment. A dietitian then screened her to create a nutrition plan for her food choices and health concerns.
Her first box of nutritious food came from Mother’s Food in February, one of two ready-to-eat companies contracted by the Inland Empire Health Plan. Each week he receives an information sheet with convenient, microwave-ready meals and macronutrient breakdowns of each meal.
“I’m on a meal schedule now,” he said. “I eat lots of meat and salads and vegetables, like broccoli and cauliflower, which is good for me.”
Fonseca, meanwhile, who is on an in-house health plan, relies on his wife and daughter to determine how to control his diabetes. After she was diagnosed in November, they jumped to learn how to cook for her by looking at recipes online.
“Before she was diagnosed with kidney disease, she ate a lot of iron-rich foods that are common to us, such as lentils and beans, but not good for kidney disease,” said her 29-year-old daughter, Maria Cruz. “We were poisoning him.”
Fonseka said he had heard of the food bank but not the food distributed at home. “The menu is very limited and specific for someone in my condition with both kidney failure and diabetes,” he said in Spanish. “Talking to a nutritionist and getting meals made especially for me for free would be a huge help.”
But although his condition makes him eligible for food delivery, it is up to the insurer to register him.
Participating in the program will reduce the work of guessing for his wife and daughter. Fonseca’s wife, Euphrasia Constantino, still works in the fields. He wakes up at 4:30 every morning to cook his breakfast before he goes to work. Her daughter prepares lunch for her, which usually consists of chicken or fish, fried vegetables and hard-boiled eggs.
“I usually drove a truck with a burito in one hand and a steering wheel in the other,” said Fonseka, an agricultural truck driver.
De los Santos, who until recently was a family earner, had to adapt to become ill. Two months ago, her husband, Fermin Silva, became caring for her state-funded payer and the couple struggled to pay rent and utilities. To save money, they will move into a two-bedroom mobile home next month.
“Now I don’t have to worry about buying my food,” he said. “I’d say I’ve saved about $ 150 a month.”
When he saves money, Fonseka spends an extra $ 100 a week buying healthy food prepared for his wife and daughter.
“We had to extend my wife’s paycheck,” Fonseka said. “We don’t fill grocery carts like we used to.”
The California Department of Health Care Services, which runs Medi-Cal, expects that patients who receive nutritious foods for treatment will tap the health system less frequently. The goal is to make people healthier by empowering them to adopt better eating habits and learn to maintain a good diet. Although some recipients may have reversible conditions, such as congestive heart failure or severe diabetes, officials still see opportunities to reduce hospitalizations and emergency room visits.
Studies have shown that providing food delivery services helps reduce healthcare costs. State officials note that food benefits will expand over time and that there is no price limit on the initiative.
But the health agency could not provide data on how many Medi-Cal patients are eligible for food and will not report the number of people receiving the service by the end of this year. According to agency spokesman Anthony Cava, the state plans to measure the cost-effectiveness of these social services as the program expands.
Inland Empire Health Plan officials say identifying the impact of a personal benefit can be challenging because many members receive multiple services. And it takes time to understand the consequences of health.
The meal of de los santos will end soon. He declined an extension, saying he had learned enough about sharing and self-control. She feels confident about continuing her healthy diet with the help of her husband, who will cook for her.
“My husband told me to slow down,” she said, “but I have a lot more energy.”
Fonseca fears that his lifelong poor eating and physically demanding jobs have affected his body. He worked in two fields in one day and traveled depending on the season of the crop. He never took leave. “Now I have time,” he said, “but dialysis makes me feel tired.”
She asked her nurse for food that was medically suitable.
“She needs to be healthy to be on the waiting list for a kidney transplant,” her daughter said. “That’s our hope.”
The story was produced by KHN, which publishes the California Healthline, the editorially independent service of the California Health Care Foundation.
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