Tentative Launch Date: Early 2026
Type: Medicaid
Program Goal: Meaningful reduction in chronic health conditions with support of MTM
Target Population: Adults with chronic nutrition related conditions
State(s): CA
What is the patient population?
Discharged from the hospital or a skilled nursing facility, or at High Risk of Hospitalization or Nursing Facility Placement
Malnutrition
Uncontrolled Diabetes (A1C > 9)
Cardiovascular Disorder
Congestive Heart Failure
Renal Failure
Stroke
Chronic Lung Disorders (COPD, CF, Emphysema, Interstitial Lung)
Human Immunodeficiency Virus (HIV)
Cancer Post-Hospitalization or Active Chemotherapy or During Radiation Therapy
Gestational Diabetes While Pregnant
Pregnancy-Induced Hypertension (PIH)
Postop Bariatric During Pregnancy or Other High-Risk Perinatal Conditions While Pregnant
Disabling mental/behavioral health disorder
What are the goals of this program?
This is a CalAIM Program, which is a DHCS initiative intended to transform Medi-Cal into a more coordinated, equitable, and person-centered system. It addresses complex social needs—such as housing, mental health, and chronic conditions.
Foodsmart supports this initiative via the Medically Tailored Meals component of the CalAIM program, whereby food is provided for members that have a chronic condition or that are at high risk of hospitalization. Members must have a chronic or acute condition, such as diabetes, heart disease, cancer, stroke, or severe mental health conditions requiring specialized nutrition. Meals are covered for 12 weeks, and can potentially be extended if medically necessary.
RD Requirements:
Health Plan Credentialing | State Medicaid Enrollment | Foodsmart Credentialing Requirements |
None | None
In California, Registered Dietitians and the KP program are part of Cal-Aim (Ancillary/Social Services) so Medicaid Provider Enrollment isn't required at this time
| Medallion Credentialing Application, Copies of CDR, license in home state, CV |
Benefits Overview:
"Authorization" refers to the 12 week window covered by a referral. Members are eligible for up to 3 authorizations for this plan.
You will see two different account names for KP in FFD:
Kaiser Permanente of Northern California (Kaiser Permanente - NCal)
Kaiser Permanente of Southern California (Kaiser Permanente - SCal)
Both follow the same program guidelines as outlined below.
Video Required
| # of Allowed Visits
| # of Allowed Units per Visit
| Schedule Cadence
|
No | First authorization period = 2 visits
*Second authorization period = 3 visits
*Third authorization period = 3 visits
*once risk assessment is submitted, the plan will determine if member is eligible for continued support | Initial: 4 units Follow up: 2 units
| First authorization:
Second and third authorization:
*see below for pictures of where to find this information in FFD |
A banner will display for KP members in two locations:
1) across the top of the chart and
2) across the top of “member management”
The banner will indicate which authorization the member is on (first, second, or third) and will populate the dates of the reauthorization window.
The reauthorization window is the date range in which a follow up visit should be scheduled, and in which an RA should be completed in order to submit the member for reauthorization.
Here are screen shots of the two locations where the banner will be displayed.
For the first and potential second authorization, the banner will display the dates in which the follow up should be scheduled to complete an RA and support food delivery timelines.
The reauthorization window dates can also be located at the bottom of “member information page” as shown here:
For the third authorization the banner will look like this, indicating the authorization end date. All visits should be scheduled and completed before this date. No RA needs to be completed within the third authorization period.
A new field has been added under “member information” where you can see which authorization # the member is on, and the “reauthorization window” start and end date.
Nutriquiz Required | SNAP Required?
| Risk Assessment Required? |
No | No | Yes - Required to complete a risk assessment at the initial visit, and at least once within the “reauthorization window”
If a risk assessment is not completed within the reauthorization window, the member may experience a gap in food support |
Risk Assessment Note
The risk assessment will show active at all times for this account.
The RA must be completed at least one time within the reauthorization window
The RA must be completed at the initial visit
Update to RA as of 3/25/26:
You will complete the RA during the “reauthorization window” displayed in the banner at the top of your KP members’ chart. If you already completed an RA within the “reauthorization window” prior to 3/25, you will need to complete another RA at the next visit (which will use the new version of the RA).
The main components of the new RA will be related to a member’s qualifying health conditions, food preferences, and documenting whether or not you are recommending food as the appropriate clinical intervention.
Please ensure your recommendation is based on that member's conditions and if there is clinical justification for food as an intervention.
Your recommendation will be the determining factor for whether a food authorization recommendation is sent to the plan.
When viewing the RA results, instead of seeing low/medium/high risk, you will see whether a food referral is recommended or not.
In future risk assessments, there will be an additional question that asks if the member is making progress on managing their conditions with the help of food support. If they aren't making progress, then no food recommendation will be sent.
Food Benefits:
Foodsmart Bucks | Foodboxes/MTM | Food Selection Instructions |
NONE | YES
12 weeks + possible extension of 2 additional 12 week periods
| See below
Estimated turnaround time after the risk assessment is submitted is 7-10 days |
Important Food Benefit Reminders:
Our goal is to minimize any gaps in food support, which can be done by completing the risk assessment within the designated “reauthorization window”.
You will see the reauthorization window date range displayed in the banner at the top of FFD, and within the member details page.
Please do not use the word “denial” when discussing your member's food support. We are not their health plan.
RDs should not tell members they are “low, medium or high risk."
Use the word “recommend” when discussing the results of our risk assessment (i.e., “I recommend 12 weeks of food be provided based on this assessment. Ultimately, your Health Plan will review this recommendation for final approval.”)
All members get food at 14 days post referral if they have not met with us by this time
Expedited members will receive food support within a few days of referral. Expedited members are determined by KP as needing immediate food support.
Food Vendors
1. Mom’s Meals
Food Benefit Type Offered: Medically-Tailored-Meals (MTM), fresh/refrigerated.
1st Delivery SLAs: Standard (5 biz days after order receipt) & Priority (2 biz days after order receipt).
Example Diet-Types Supported: General wellness, diabetes-friendly, lower sodium, heart-friendly, renal-friendly, gluten-free, vegetarian, pureed, and protein+.
Cuisine & Cultural Options: Traditional American, Italian (e.g., Chicken Alfredo), and international flavors (Korean-style BBQ, Green Chile Chicken). Offers Kosher and Halal meal options.
2. Modify Health
Food Benefit Type Offered: Medically-Tailored-Meals (MTM), fresh/refrigerated.
1st Delivery SLAs: Standard (5 biz days after order receipt) & Priority (2 biz days after order receipt).
Conditions Supported: Diabetes/pre-diabetes, renal (CKD), heart health (CHF, hypertension, cardiovascular), fatty liver (NAFLD), IBS, IBD, GLP-1/weight management, Celiac (gluten-free), PCOS, and cancer.
Cuisine & Cultural Options: Global focus across 6 continents including Hispanic/Latin America, Asian, South Asian, Middle Eastern, Traditional/Southern American, and European.
3. Homestyle Direct
Food Benefit Type Offered: Medically-Tailored-Meals (MTM), frozen.
1st Delivery SLAs: Standard (5 biz days after order receipt) & Priority (2 biz days after order receipt).
Conditions Supported: Diabetes, heart disease, renal, maternal health, pediatrics, higher protein/calorie needs, gluten restricted, vegetarian, pescatarian, low-sodium, and vegan.
Cuisine & Cultural Options: Traditional American, Asian, Middle Eastern, and Latin/Mexican. Menu updates 2x/year to incorporate new member feedback and preferences.
4. Roots Food Group
Food Benefit Type Offered: Medically-Tailored-Meals (MTM), frozen.
1st Delivery SLAs: Standard only (5 biz days after order receipt).
Conditions Supported: Diabetes, hypertension, heart disease (CHF/stroke), obesity (Class III), malnutrition, mental health (depression/PTSD), limited mobility, kidney disease, cancer, thyroid, high-risk pregnancy, GERD, and eating disorders.
Cuisine & Cultural Options: American, Latin American, Mexican, Caribbean, African, Middle Eastern, Mediterranean, and Asian (East, SE, South). Offers Kosher, Halal, Pork-free, Dysphagia, and Vegan options.
5. Sunterra / Project Food Box
Food Benefit Type Offered: Grocery Boxes; majority of products sourced directly from California farmers.
1st Delivery SLAs: Standard (5 business days) only.
Conditions Supported: Alzheimer’s/Dementia, Autoimmune, Cancer, Cardiovascular/CHF, Celiac, CKD/ESRD, COPD/Asthma, mental health, diabetes, GI/IBD, liver disease, obesity, and high-risk perinatal.
Cuisine & Cultural Options: American, Latin, Asian, Mediterranean, Middle Eastern, African, and plant-based options.
6. Food Health Collective
Food Benefit Type Offered: Grocery Boxes; majority of products sourced directly from California farmers.
1st Delivery SLAs: Standard (5 business days) only.
Conditions Supported: Heart disease, diabetes/pre-diabetes, food allergies, digestive/GI issues, obesity, cancer, hypertension, renal, autoimmune, maternal health, and eating disorders.
Cuisine & Cultural Options: Caribbean (Haitian, Jamaican, etc.), Central/South American (Peruvian, Colombian, etc.), Asian (Vietnamese, Thai, etc.), African (West/North/Ethiopian), Middle Eastern, Mediterranean, Southern, and European.
FAQS:
What do I do if a member has an initial visit with me outside of the reauthorization window?
Possible scenarios:
If the initial visit falls before the reauthorization window, schedule the follow up visit within the reauthorization window. You will need to complete a risk assessment within the reauthorization window in order for the member to be submitted for reauthorization.
If the initial visit falls within the reauthorization window, you can schedule the follow up visit as clinically indicated any time before the authorization end date. You will need to complete a risk assessment within the reauthorization window in order for the member to be submitted for reauthorization.
If the initial visit falls after the reauthorization window (but still before the authorization end date), you will need to complete a risk assessment to submit the member for reauthorization. In this scenario, the member may experience a gap in food support but could still be eligible for additional visits and food. You are still able to schedule one follow up visit any time before the authorization end date.
Is there a lifetime max for this program?
Benefits do not renew annually, but members may qualify for additional benefits after 36 weeks if they obtain a new qualifying health condition. In this case, a new referral based on the new condition will be sent to foodsmart and a new 12 week authorization window would begin.
Kaiser Permanente Provider Manuals
Please see the following link of Overview of Health Plans for info on all health plans.