Food Insecurity Hits Disabled and Vulnerable Medicare Enrollees

Medicare’s move to allow home-delivered meals as a supplemental benefit next year may be just what the doctor ordered.

An estimated 40% of Medicare enrollees under age 65 with a physical or mental impairment experienced food insecurity—the financial inability to get adequate nutrition—at some point in the last year, according to a study published Sept. 30 in JAMA Internal Medicine. That compares with just 9% of beneficiaries age 65 and over.

“The pervasive food insecurity across segments within the disabled group is striking,” read the report authored by researchers at Northeastern and Harvard universities.

The findings come as some private health plans that provide Medicare benefits prepare to offer nonmedical assistance, like home-delivered meals, as a supplemental benefit in 2020.

These Medicare Advantage plans have higher shares of members with medical and social risk factors, like serious mental illness and drug abuse problems, than fee-for-service Medicare. They also have higher rates of low-income enrollees who receive both Medicare and Medicaid benefits. One in three of these “dual eligibles” reported food insecurity of some sort in the last year, the JAMA report found.

The rate was nearly 26% among Medicare seniors with annual incomes below $15,000. About one quarter, or 15 million, of Medicare’s older adults and people with disabilities have incomes below $15,250 and less than $14,550 in savings.

Affecting Health

Medicare protects beneficiaries from catastrophic health-care bills and helps keep many out of poverty. But the findings—which represented nearly 51 million Medicare enrollees nationwide—suggest that large swaths of older and vulnerable enrollees face additional nonmedical problems that could adversely affect their health.

“These are folks that we’re paying a fair bit of money to cover their health expenses, but they don’t have enough to eat. So it’s a threat to their health, which to me is just as concerning as if they had difficulty accessing care,” said Jeanne M. Madden, lead author of the study and associate professor in the Department of Pharmacy and Health Systems Sciences at Northeastern University.

Using a U.S. Department of Agriculture questionnaire, nearly 9,700 beneficiaries were asked if they had run out of food, had no money to get more, couldn’t eat balanced meals, skipped or ate smaller meals, ate less than they wanted, or went hungry due to a lack of funds in the last year. Those who answered “yes” to at least two questions were determined to be “food insecure.”

According to the report, “the findings highlight the appropriateness of the Centers for Medicare & Medicaid Services’ intensifying focus on social determinants of health,” to address nonmedical problems, like hunger, that can endanger patients’ health and lead to costly hospitalizations.

More caregivers are screening patients for social problems like sexual abuse, hunger, and domestic violence, Madden said. But a recent survey in JAMA Network Open found that less than 40% of 739 hospitals screened patients for food insecurity, while just 30% of nearly 2,200 physician practices did so.

Hunger is the most extreme form of food insecurity, but the most commonly reported problem is running out of food and not having money to buy more, Madden said.

Important risk factors for food insecurity among Medicare enrollees include multiple chronic conditions and symptoms of depression and anxiety. Limited ability to perform daily living activities is an additional risk factor for the elderly, Madden said. While these ailments were associated with food insecurity, the study did not show them to be a cause.