Feeding Health: The Essential Role of Community-based Organizations

As the health care landscape evolves to adopt health-related social needs (HRSN) interventions and innovative Food Is Medicine initiatives, CBOs emerge as indispensable allies in this paradigm shift. Their deep-rooted community connections act as a bridge between institutional health care and the experiences of diverse populations, providing an intimate understanding of local needs and resources. Furthermore, CBOs serve as cultural translators, ensuring that Food Is Medicine interventions resonate with the communities they aim to serve.

State and Federal agencies are increasingly fostering partnerships with CBOs to integrate medical, behavioral, and social health services. The Centers for Medicare & Medicaid Services (CMS) supports state innovation through demonstration opportunities and other Medicaid authorities. Section 1115 demonstrations allow states to test new approaches in Medicaid service delivery, including nutrition-related and other supportive services, which CMS reviews on a case-by-case basis consistent with federal Medicaid requirements.

States may use these demonstrations to expand the range of services available to certain Medicaid beneficiaries, creating opportunities for CBOs to contribute to service delivery in areas traditionally outside the scope of Medicaid coverage. Demonstrations also include evaluation requirements to assess utilization, quality, and outcomes.

Medicaid Managed Care Organizations may also offer services or settings in lieu of those covered under the state plan (commonly referred to as “in lieu of services” or ILOS). These services can include nutrition and other supportive services not typically covered under standard Medicaid benefits. Many states encourage managed care plans to conduct screenings, make referrals, and partner with CBOs to deliver services in community settings.

Effective collaboration between CBOs and health care organizations can present challenges due to differing operational, technological, and financial models. To support successful partnerships, states and health care organizations may:

• Define clear roles for CBOs in program design and implementation
• Provide sustainable funding and contracting pathways
• Support infrastructure development, including data and technology capacity
• Offer technical assistance and training
• Invest in shared platforms that enable secure data exchange and care coordination

State Medicaid agencies continue to highlight the importance of collaboration with community partners to improve service delivery and health outcomes. Through policy and program design, states are creating opportunities for CBOs to participate in delivering nutrition and other supportive services.

In Lieu of Services (ILOS)

Michigan Medicaid Health Plans

Beginning in 2024, Michigan’s Medicaid Health Plans introduced ILOS [PDF - 193 KB] that include services addressing food and nutrition-related needs. Community partnerships are central to these efforts, as plans are expected to develop provider networks that include locally based organizations. In the final ILOS Policy Guide, the Michigan Department of Health and Human Services (MDHHS) stated its preference and requirements for plans to contract with Michigan-based community organizations.

MDHHS has a strong preference for ILOS Providers to be locally based. However, MDHHS recognizes that locally based ILOS Providers may need to develop infrastructure, capacity, and experience to deliver ILOS. In contract year 2025, MDHHS is requiring that at least 30% of each ILOS service type must be delivered by locally based providers, as measured by service volume.

To be a locally based ILOS Provider, an organization must:

• Be a CBO
• Have a physical presence in Michigan, defined as having one or more office locations in Michigan ― preferably in the Region(s) the ILOS is provided
• Participate in the Michigan food economy

Locally based ILOS Providers may also include independent community grocers and direct marketing farmers that meet state criteria.

Throughout the planning of its ILOS implementation, the Michigan Department of Health and Human Services engaged the community in various ways. In March 2024, it released a Request for Information seeking public feedback on its four proposed evidence-based ILOS [PDF - 320 KB] as well as their proposed populations that would be eligible for such services. The agency also sought input from external partners [PDF - 2.4 MB] upon drafting the ILOS Policy Guide in July 2024.

California Department of Health Care Services 

Through California Advancing and Innovating Medi-Cal (CalAIM), the state is working to build a more coordinated, person-centered system.

One of CalAIM’s key initiatives is Community Supports [PDF - 544 KB] (also known as ILOS), which include services designed to address a range of needs, including nutrition.  

Medi-Cal Managed Care Plans are required to partner with CBOs to offer Community Supports and create a robust provider network for their 14 Community Supports services. CalAIM relies on community-driven referrals and connections. From the California Department of Health Care Services:  

By the end of Q2 2023, managed care plans reported having approximately 1,374 provider contracts active for Community Supports. 

Section 1115 Demonstrations

Oregon

Oregon's Section 1115 Demonstration underscores the critical role of CBOs in delivering supportive services, emphasizing culturally appropriate, responsive, and trauma-informed care. The state was approved to receive community capacity-building funding for CBOs, dedicated to investments supporting infrastructure for service delivery. These funds will be distributed to providers through a collaboration between the Oregon Health Authority and coordinated care organizations. Leveraging Connect Oregon, the state’s coordinated social care network, nine coordinated care organizations across Oregon are adopting a scalable payments solution to streamline the community reimbursement process and build capacity for community-based providers. Additionally, the Oregon Payments Workgroup is working to standardize workflows and processes for implementing supportive benefits, which will help CBOs integrate more seamlessly into the system.

Private Payer Partnerships with CBOs

Partnerships with CBOs also enable private payers to take a more comprehensive approach to improving health outcomes. By leveraging community-based knowledge and relationships, payers can strengthen service delivery and better connect individuals to nutrition and other supportive services.

Through California Advancing and Innovating Medi-Cal, managed care plan contracts with CBOs to provide Community Supports, with nearly 2,500 provider contracts launched since implementation began. Analysis of 19 California health plans showed that over half had contracted with national for-profit companies to offer Community Supports or Enhanced Care Management services, suggesting that CBOs with substantial financial resources are more likely to secure contracts.

The integration of CBOs into health care delivery through Food Is Medicine initiatives continues to evolve as states, health plans, and community partners explore new ways to improve nutrition and overall health outcomes.

Medicaid authorities, including Section 1115 demonstrations and ILOS, provide pathways for states to test innovative approaches that incorporate nutrition and other supportive services into care delivery.

State experiences demonstrate the important role of CBO partnerships in improving coordination and expanding access to services. These efforts offer practical insights for other states and organizations seeking to strengthen connections between health care and community-based supports.

Successful partnerships are supported by shared goals, clear communication, and sustainable operational and financial models. Providing technical assistance, strengthening infrastructure, and supporting data sharing can help CBOs participate effectively in these efforts.

As Food Is Medicine initiatives continue to develop, ongoing collaboration and refinement will be important to ensure programs are practical, scalable, and focused on improving health outcomes.