WASHINGTON — They’re marketed as wholesome, “dietitian-approved” meals and delivered on to the properties of individuals significantly in poor health from most cancers, diabetes, or coronary heart illness: a Jimmy Dean frozen sausage breakfast sandwich, biscuits and gravy, a cheeseburger.
These are among the many choices offered by an Idaho-based firm, Homestyle Direct, which is paid thousands and thousands of {dollars} every year by taxpayer-funded state Medicaid applications to ship what the corporate calls medically tailor-made meals. The corporate, which advertises delivering 7.8 million meals yearly, has menus catering to prospects making an attempt to handle their most cancers and diabetes, in addition to “coronary heart wholesome” and “renal pleasant” dishes.
Nevertheless, a number of vitamin specialists instructed STAT that a lot of Homestyle Direct’s choices fall far in need of what they’d contemplate medically tailor-made meals, a category of meals which have been confirmed to assist these affected by diet-related situations enhance their well being and keep out of the hospital. Most additionally don’t seem to fulfill new voluntary accreditation requirements crafted by medically-tailored meal suppliers.
“Homestyle Direct to me doesn’t seem like medically tailor-made meals in any respect — it doesn’t even seem like usually wholesome meals,” stated Dariush Mozaffarian, director of the Meals is Medication Institute at Tufts College.
The corporate’s potential to invoice Medicaid for meals loaded with sodium and saturated fats — a few of which may very well be purchased within the grocery retailer at a lot decrease price — raises questions on federal and state oversight of meal supply applications for individuals largely confined to their properties, that are operated underneath a provision of the Medicaid program referred to as a Residence and Neighborhood-Primarily based Providers waiver.
Whereas there’s no universally accepted definition for a medically tailor-made meal, most vitamin specialists say they need to be low in sure elements like sodium, added sugar, and saturated fats, and excessive in others, like fiber. Many additionally anticipate these meals to be freed from the components, just like the preservatives and stabilizers that usually lace unhealthy processed meals.
Homestyle Direct’s Jimmy Dean breakfast sandwich — supplied as a part of its diabetes menu — boasts 980 milligrams of sodium. The corporate’s cancer-support and diabetes-friendly biscuits and sausage gravy has greater than half the sodium and saturated fats that specialists advocate wholesome adults devour in a single day. And its cheeseburger has roughly 50 elements — a tell-tale signal of so-called “ultra-processed” meals. The cheeseburger is marketed as serving to prospects with most cancers, diabetes, renal points, and coronary heart issues, even though consumption of ultra-processed meals has been associated with sort 2 diabetes, coronary heart disease-related mortality, and sure types of most cancers.
Homestyle Direct is simply one of many for-profit firms that invoice Medicaid applications for home-delivered meals. Magic Kitchen sells its personal model of biscuits and gravy, with 1,110 milligrams of sodium and 12 grams of saturated fats. One other firm, Mother’s Meals, sells a “cheeseburger soup” with pretzel bits, oatmeal cream pie, and milk that altogether has 930 milligrams of sodium and 12 grams of added sugar.
Jeff Barteau, CEO of Homestyle Direct, stated the corporate follows state guidelines governing meals’ dietary content material and that the corporate strives “to steadiness dietary pointers with palatability and cultural preferences.”
“Our purpose is to make medically tailor-made meals extra extensively out there, particularly to these residing in meals deserts or rural communities,” he wrote in a press release. “It’s vital to notice that there are presently no common requirements for medically tailor-made meals or particular requirements for every illness class.”
The CEO of Magic Kitchen, Greg Miller, equally stated his firm tries to “cater to as many several types of … diets and cultures that we are able to,” including that the biscuits and gravy had been requested by a number of prospects. That meal’s sodium content material is greater than nearly all of his firm’s meals, he stated, and it isn’t meant for individuals on a sodium-restricted weight loss plan.
Teresa Roof, a public relations supervisor for Mother’s Meals, stated the corporate really elevated the energy and vitamins of its cheeseburger soup meal by means of providing sides in order that it might meet sure Medicaid dietary pointers. “Sides assist us guarantee we’re offering sufficient energy and vitamins to maintain enough vitamin total,” Roof stated. “Wholesome consuming is all about steadiness.”
States set their very own guidelines for Medicaid meal applications, they usually usually set very unfastened restrictions governing the dietary content material of the meals. The states STAT queried solely required that the meals despatched to sufferers present no less than one-third of the vitamins that an individual’s is meant to devour in a day, which is named the Dietary Reference Consumption.
“It’s a spot the place we have now lacked requirements for extra nutritionally sound meals,” stated Rachel Landauer, a scientific teacher on the Middle for Well being Regulation and Coverage Innovation at Harvard Regulation Faculty. She famous that these meal providers have been initially conceived to assist individuals who might need issue leaving their properties entry meals, relatively than to ship meals meant to enhance vitamin.
Advocates concern that firms like Homestyle Direct are trying to benefit from the rising Meals is Medication motion, which goals to higher combine wholesome meals into conventional well being care.
Medically tailor-made meals have been primarily supplied by nonprofit, community-based organizations for the reason that providers started within the Eighties to offer wholesome meals to individuals dying of AIDS. That has begun to alter, nonetheless, as Meals is Medication has change into in vogue in Washington, gaining the backing of the Biden White Home, in addition to nationwide organizations just like the American Coronary heart Affiliation and the Rockefeller Basis.
“There are various firms … now making an attempt to rebrand their meals as medically tailor-made meals when they don’t seem to be,” stated Mozaffarian. “It’s an issue … It hurts the motion and extra importantly it hurts the sufferers.”
Homestyle Direct’s rebrand as a medically tailored-meal supplier seems to be comparatively latest. Archives of the corporate’s web site relationship again greater than twenty years reveal it started claiming that it was promoting medically tailor-made meals solely in 2023.
The corporate started working in 1997, and in its early years pitched itself primarily as a meal-delivery service for individuals with busy lives. “What number of instances have you ever come residence on the finish of an extended day solely to find that nothing was deliberate for dinner and you might be too drained to make it anyway?” the corporate’s homepage requested in 2001.
By 2009, Medicaid applications in six states have been reimbursing the corporate for its meals. That quantity ballooned to 18 by 2018. And now, the corporate is reimbursed in 30 states.
With that enlargement have come authorized troubles. In 2009, Oregon kicked the corporate out of its Medicaid program as a result of it despatched sufferers frozen meals on a month-to-month foundation, although Oregon’s program required meal suppliers to ship scorching meals every day. The corporate unsuccessfully appealed the choice as much as the Oregon Supreme Courtroom, arguing that the state unlawfully modified this system’s guidelines. In 2015, Homestyle Direct paid $357,000 to settle a federal lawsuit over claims the corporate billed Medicaid for desserts that weren’t lined by this system, shipped extra meals to sufferers to gather Medicaid checks, and even billed Medicaid for meals allegedly offered to sufferers who in reality have been deceased.
The transfer into promoting medically tailor-made meals coincided with a big funding within the firm by the non-public fairness agency Harkness Capital Partners in 2021. Harkness additionally invests in a college lunch firm, a roofing supplier, and a pump rental service firm.
In a press launch saying the funding, the CEO of Homestyle Direct stated that Harkness’ involvement would “present capital and strategic operational sources … at a great time to assist our speedy development.”
Harkness Capital stated in a press release that it’s “dedicated to supporting firms that uphold excessive requirements of high quality and integrity” and that “since our funding in March 2021, HSD has demonstrated this dedication in serving Medicaid beneficiaries.”
Several of the main Meals is Medication-focused nonprofits unveiled an accreditation program for medically tailor-made meal suppliers earlier this 12 months in hopes of standardizing their high quality. Lots of Homestyle Direct’s choices seem to not meet these requirements.
The corporate, for instance, gives fried meals, resembling fried hen, which the Meals is Medication Coalition’s requirements contemplate unacceptable.
These pointers additionally recommend that medically tailor-made meals ought to usually have between 700 and 800 milligrams of sodium, relying on the situation being handled. Lower than half of the meals supplied by Homestyle Direct meet that concentrate on.
A number of of the corporate’s meals additionally include little to no fiber, which research have correlated with coronary heart well being, and decreased threat of sure types of most cancers and all-cause mortality. Gadgets on Homestyle Direct’s “coronary heart pleasant” menu include a mean of 5 grams of fiber per meal, in response to STAT’s evaluation. The accreditation requirements advocate between 8 and 9 grams of fiber per meal for many diets.
Barteau, the CEO, instructed STAT the corporate gives “supplemental gadgets for all Medicaid beneficiaries, together with oatmeal or supplemental drinks that supply extra fiber, dairy, and nutritional vitamins.”
The pinnacle of the Meals is Medication Coalition declined to touch upon the meals supplied by firms, stating that the coalition would want to overview extra than simply the dietary content material of the meals to find out in the event that they met the standards for accreditation.
Medicaid accounts for 98% of Homestyle Direct’s income, in response to Barteau, although he wouldn’t say how a lot it takes in from this system, which is collectively funded by states and the federal authorities. STAT confirmed by means of public report requests to only three states that it’s within the thousands and thousands yearly.
Oklahoma paid Homestyle Direct $6.2 million in 2023, and Idaho paid the corporate $1 million that 12 months. South Carolina has paid the corporate $2.8 million up to now this fiscal 12 months.
The lax Medicaid requirements for dietary high quality are possible a byproduct of how this system that pays for these meals was conceived, argued Landauer, the Harvard professor.
“It was actually extra about focusing on of us who could also be homebound and in jeopardy of being meals insecure … much less so on actually guaranteeing enough entry to nutritious meals,” she stated. “It’s such an vital level to be asking this query: Does that also serve us? Is that also the place the main target ought to be? Or can we be striving for greater than that?”
STAT requested a number of states that contract with Homestyle Direct whether or not they have been involved that susceptible sufferers would possibly buy the businesses’ meals considering they’re wholesome. Officers in a number of states emphasised that the meals observe the authorized customary, and that sufferers are free to decide on the meals that match their life-style.
“Oklahomans who obtain residence delivered meals by means of the … waiver program have selections as to who they choose as a meal supplier and the kind of meal they select,” stated a spokesperson for Oklahoma Human Providers, which contracts with Homestyle Direct.
Homestyle Direct advertises that it additionally contracts with non-public Medicare plans, nonetheless these contracts will not be topic to public disclosure.
Clients can even buy instantly from Homestyle Direct for $9.95 every. That value is commonly a lot greater than sufferers would pay in the event that they purchased the identical meals on the grocery retailer. A Jimmy Dean breakfast sandwich, for instance, prices $1.37 per sandwich at Walmart — although the Homestyle Direct meal additionally comes with diced candy potatoes.
“Truthfully for a few of these, sufferers could be higher simply giving them a Wholesome Alternative frozen dinner,” stated Jessica Peters, outpatient vitamin supervisor at Boston Medical Middle Well being System.
Barteau stated the upper value for the meals incorporates “not simply the price of meals, but in addition the great service of making ready, packaging, and delivery frozen meals on to recipients’ doorways throughout a number of states.”
He stated the corporate makes use of a community of refrigerated long-haulers and FedEx hubs to take care of meal high quality throughout delivery.
Nevertheless, when STAT bought a number of Homestyle Direct meals final month, the meals arrived thawed and unsafe to eat.
Barteau stated in a press release that the corporate follows state pointers for meal high quality, however that the problem of heat meals being delivered “is very uncommon,” “not consultant of our customary service,” and because of the truth that the corporate doesn’t usually serve Massachusetts, the place STAT is headquartered.
STAT’s protection of continual well being points is supported by a grant from Bloomberg Philanthropies. Our monetary supporters will not be concerned in any choices about our journalism.
