Social Determinants of Health
Make sure your clients know their options
by Phil Wilkins

Medicare Advantage (MA) enrollment for 2022 recently concluded, and the focus on social determinants of health (SDOH) has never been more intense. MA plans are incorporating new services to address SDOH factors that can put patients at higher risk of poor outcomes. That includes programs that address food insecurity.

Meal and nutrition benefits are increasingly common offerings in MA programs, as evidenced by a recent comparison of 2022 plans. According to Avalere, 68% of 2022 plans include meal benefits, up from 55% in 2021. Meanwhile, 30% of plans offer nutrition benefits, compared to 17% in 2021. Also, 40% of MA plans offer the meal benefit at no additional cost to the member.

However, to ensure that members take advantage of these meal and nutrition benefits—and to improve health outcomes—industry leaders must increase awareness about these programs and improve participation among eligible adults.

Food Insecurity & the Pandemic

Food insecurity is not a new issue, but the pandemic has magnified the problem for all age groups, races and genders. In the Journal of Hunger & Environment, researchers explained that, “before COVID-19, wide disparities in food insecurity were stark with rates elevated above the national average for poor households, households with children, single-parent households, people living alone, and Black- and Hispanic-headed households.”

As the pandemic hit, many companies laid off or furloughed staff and supply chains collapsed, creating shortages on everything from paper goods to food.

“The overnight shutdown of restaurants, schools, worksites and many other institutions due to COVID-19 increased demand for food at home and created food supply disruptions in grocery stores and the charitable feeding system,” according to the American Journal of Clinical Nutrition. The authors of the same report noted that the pandemic exacerbated existing disparities in food insecurity and chronic disease—issues that they predict will persist even after the pandemic ends.

Individuals who are food insecure often face additional challenges due to other SDOH, such as where they live, their employment status, their age and their race. These challenges can create situations where people must choose between paying for food and for other basic needs, including medication and rent. According to the Root Cause Coalition, 37% of individuals who express worry about not having enough to eat report not having enough money to buy food, and 30% say they have used their money to purchase other necessities.

The pandemic worsened an already fragile community-based food-security system for many and created unexpected difficulties, including:

  • New or ongoing economic disparity
  • Chronic and acute health conditions
  • Faltering health caused by a poor diet
  • New household stressors

Food insecurity disproportionately impacts some racial and ethnic groups. For example, a study of two low-income predominantly Black neighborhoods in Pittsburgh revealed that food insecurity grew nearly 80% from March to May 2020. Researchers note that during the first few weeks of COVID-19, certain racial or ethnic groups experienced food insecurity at a rate that “far outpaced the increase in the general U.S. population,” magnifying preexisting disparities in food security that impact a wide variety of health outcomes.

Improving Access & Increasing Knowledge of Options

Individuals living with food insecurity often aren’t aware of their options for obtaining access to healthy, affordable food, leaving 24% of Americans to worry about having enough to eat. In particular, older adults living in food deserts may opt for inexpensive and less healthy food options because they don’t know how to access more affordable, healthy choices.

Hunger and food insecurity is a huge problem for our country’s most vulnerable members—and an issue that 76% of Americans say should be a top priority for policymakers. For older Americans, MA programs that consider SDOH offer a means to address the challenges, though many seniors are not aware of available benefits. Thus, an important first step to addressing food insecurity challenges among older Americans is to improve access to existing subsidies that are underused or, in some cases, not utilized at all.

For example, even though more MA programs now include meal benefits, an estimated 5 million older adults don’t take advantage of food benefits for which they are eligible. The Food Research & Action Center shows food benefit participation among older adults is approximately 24% nationwide; in New York, a state with a relatively high participation rate, 70% of eligible older adults take advantage of food aid; in California, a mere 19% of eligible adults receive aid.

In addition to increasing the awareness of food benefit programs an what is available to them, education can help older adults understand how these initiatives can benefit their short- and long-term health.

One study of 60,000 low-income older adults in Maryland found that participants who took advantage of the food benefit were 23% less likely to enter a nursing home and 4% less likely to be hospitalized than those who didn’t participate. Eligible seniors who do not participate in such programs may be at increased risk of hunger and thus hunger-related health problems such as diabetes, hypertension and depression, the Food Research & Action Center finds.

By working to educate eligible seniors about the meal and nutrition benefits in their MA plans, the industry has the opportunity to significantly improve health outcomes for millions who suffer from food insecurity.

Phil Wilkins is senior vice president of social determinants of health at Modivcare. His commitment to addressing the social determinants of health started at home, where he saw numerous family members struggle with poor health that led to diabetes and amputations, which led to insecurities in transportation, housing, finances and food—and, ultimately, a requirement for supportive personal care to meet the demands of everyday life. Wilkins is a graduate of Miami Univeristy and has successfully completed Cornell University’s Diversity Management Program. Visit