Within each of these departments doing such incredible work, how is values-based procurement prioritized for any of these programs if at all?

CDC developed the Food Service Guidelines for Federal Facilities (FSG) to improve access to healthier foods and beverages at federal facilities. The FSG provides specific standards for food and nutrition (aligned with the Dietary Guidelines for Americans), energy and waste reduction, sourcing of local foods, food safety, and behavioral design (strategies to encourage selection of healthier foods). Beyond federal facilities, FSG can be used widely in states and communities for hospitals and healthcare facilities, private worksites, and other settings where food service is offered.

An example of values-based procurement is the VA Subsistence Prime Vendor Contract, where health-care focused requirements are set and select product categories annually standardized by end-users of the contract to ensure high quality products are evaluated and available:  Subsistence Prime Vendor (SPV) – Office of Procurement, Acquisition and Logistics (OPAL) (va.gov).  


Is there a catalog of federal food policy [and programs] across agencies and departments?

Given the breadth of federal food policies and programs across the federal government, there is not a centralized place where they are catalogued. However, as it relates to Food is Medicine, the Department of Health and Human services is in the process of creating an evidence-based toolkit that will include a landscape analysis of relevant federal programs and policies. This will be available in Summer 2024. To learn more, visit: https://health.gov/our-work/nutrition-physical-activity/food-medicine.


If MyPlate is the federal symbol for healthy eating per USDA, would the FDA consider using the MyPlate icon as their new “healthy” logo? If not, why?

FDA is conducting research on the healthy symbol and so any discussion of specifics of the design would be preliminary at this point, but the question and the input is appreciated.


At the VA and other pilots, do the produce prescriptions include produce in all forms (fresh, frozen, canned)? If fresh only, will you consider expanding?

The authorizing legislation for the GusNIP Produce Prescription Program, 7 U.S.C. 7517 (c), specifies that projects must prescribe fresh fruits and vegetables. NIFA recognizes that food supply and food system disruptions may hinder the ability to access fresh fruits and vegetables. NIFA also encourages applicants to propose projects that emphasize culturally sensitive food and/or food practices. If these may impact the range of fresh fruits and vegetables that will be prescribed, they should be thoroughly described and justified in the grant application.  


The Fresh Connect Produce Prescription pilot programs in the Veterans Health Administration’s (VHA) medical centers in Salt Lake City and Houston are available for fresh produce (non-processed fruits and vegetables) only. 


In the Food As Medicine Whole System Approach, the exterior layer notes “Food Production Quality”, what does “production quality” mean? 

This refers to the process in which food is grown and produced. For example, is food produced in a way that considers soil conservation or rehabilitation? Is the process sustainable? Does the process demonstrate value and dignity for the people and animals involved in creating the food? This is but one of many components listed as a potentially enabling condition by which food as medicine concepts can be scaled to facilitate improvement in health outcomes. 


How do you reconcile federal coordination on FAM with the fact that states have so much influence in how 1115 waivers and Medicaid are administered?

1115 waivers are but one way of establishing FAM initiatives.  FAM approaches are increasingly present across many communities and systems. States and state coalitions have an important leadership role in understanding the context and developing an implementation strategy that supports the needs and the context that will make FAM interventions most sustainable. Federal partners can help provide support through guidance, best practices, tools, and other mechanisms to ensure the development of high-quality approaches. There is also increasing federal investment and action to support Food as Medicine approaches in these settings (e.g., the role of NIH in stimulating research; produce proscription programs funded by USDA, VA, and HHS; and meal delivery or transportation to and from food access points by the Department of Transportation). The federal government can work collectively to establish metrics that help define success in such initiatives and help establish best practices that can be the basis for developing programs under 1115 waivers or via other means.


What are the VA and CMS doing to ensure healthy food cards work within all Point-of-sale systems at all grocery retailers?

The VA and CMS are part of a larger Food as Medicine federal working group that is meeting regularly to identify and address barriers, such as the one identified in this question. Ensuring equitable access to services and benefits covered by CMS programs is critically important. CMS welcomes feedback from interested parties on barriers to access and opportunities to improve the efficacy and reach of our programs. 

The VHA Fresh Connect Produce Prescription pilot program in Salt Lake City and Houston VHA medical centers is available at Kroger-chain grocery stores. It is funded by the Rockefeller foundation in partnership with the Fresh Connect program. Kroger is part of the Fresh Connect network, a food prescription program operated by food access nonprofit, About Fresh. Salt Lake City and Houston were chosen in-part for their proximity to the Kroger-chain grocer.


Can individuals (diagnosed or undiagnosed) mental health challenges be exempted from the SNAP ABAWD rule?

Yes, if you are unable to work due to a physical or mental limitation, you can be exempted from the ABAWD time limit. SNAP State agencies can exempt an individual if they receive disability payments, are obviously mentally or physically unfit for work or, if the unfitness is not obvious, based on a statement from a medical professional or another acceptable source (such as a social worker).


What specifically do you attribute the enrollment of so many (400K!) people in WIC last year compared to no enrollment growth in the recent past?

Several factors could be contributing to increases in WIC participation including increases in birth rates and a higher-valued food package that supports the purchase of fruits and vegetables through the cash-value benefit. WIC is one of the nation’s most effective public health programs, with a long history of improving health and developmental outcomes for children. USDA continues to invest in WIC to reach more eligible families, encourage families to redeem more of their food benefits, and advance equity. For more information on efforts to modernize WIC see: WIC Modernization | Food and Nutrition Service (usda.gov)


As we think of Food as Medicine, how will the federal government define “healthy” food that can be part of the programs (i.e., medically tailored meals)? 

Within the federal government we rely on the Dietary Guidelines for Americans, which reflect the current body of nutrition science, to provide advice on what to eat and drink to meet nutrient needs, to promote health, and prevent disease. However, what is appropriate (“healthy”) for a “patient” in an MTM, Rx Grocery, or other FAM program will reflect individual needs and ought to be defined by good clinical practice by multidisciplinary teams – including registered dietitians.