Food is a critical part of managing many chronic diseases. Yet after a hospital stay, older adults may return home without the sustenance they need to recover and stay healthy. The Medically Tailored Home-Delivered Meals Pilot Act (H.R.5439/S.2834) was recently introduced in Congress. It would test whether Medicare coverage of medically tailored meals (MTMs) after hospitalization improves health outcomes and reduces healthcare costs. As almost all older adults have at least one chronic disease, the results of this pilot are critical to improving their health. To ensure that the MTM pilot is as effective as possible, hospitals should partner with their local community Older Americans Act (OAA) Nutrition Programs, which already deliver meals and services to millions of older adults nationwide. This reflects our experiences as researchers and practitioners working on community nutrition programs and malnutrition prevention.
Strong Community Partners Will Determine the MTM Pilot’s Success
In the H.R.5439/S.2834 MTM six-year pilot, 40 hospitals will partner with community organizations to deliver two MTMs a day for at least 12 weeks to older adults with diet-related diseases. Medically tailored meals are designed by a Registered Dietitian Nutritionist to meet the specific nutritional needs of individuals with severe, chronic, or complex health conditions. Research shows that providing older adults these meals, along with nutrition education and counseling, during recovery from hospitalization reduces healthcare expenditures and improves recovery. These supports help improve nutritional status, wound healing, strength, and immune function.
Partnering with established community-based organizations increases the likelihood of success.
To make effective policy decisions, policy makers need strong evidence demonstrating that MTMs impact health outcomes and healthcare costs. Without strong community-based partners, the pilot may struggle to demonstrate these effects, given that poor coordination of care after hospital discharge frequently drives up healthcare costs. Managing community-based care through hospital outpatient departments is often considered the highest cost approach. In contrast, partnering with established community-based organizations increases the likelihood of success. The OAA nutrition program offers a particularly strong foundation. For over 50 years, it has delivered nutritious meals, supported social connection, and adapted meals to local cultural preferences and dietary needs. Their high quality services are cost effective, responsive to communities, and designed to address health-related social needs. With the OAA aging network’s 20,000 organizations nationwide, MTM pilot hospitals have the opportunity to align with well-established and successful partners in virtually every community (See Figure 1).
Figure 1: The Aging Network Overview. These organizations coordinate closely or have a combined mission with disability services.
Source: Adapted from Congressional Research Service, Older Americans Act: Overview and Funding, CRS Product Number R43414, May 6, 2024.
Older Adults Already Trust Their Local OAA Programs
For older adults and people with disabilities, OAA organizations are trusted non-profits and government agencies that provide person-centered assessments and service navigation, as well as connections to services they need to live independently in their communities. Participants value OAA meals not only for their nutritional quality but also because they incorporate cultural preferences and individual needs.
For every federal OAA dollar provided, the aging services network leverages another four dollars from state, local, and private sources.
The OAA nutrition program’s goals include reducing hunger, food insecurity and malnutrition; increasing socialization; and enhancing health and wellness. It serves over 1 million meals daily nationwide. These meals are developed under the oversight of Registered Dietitian Nutritionists and must meet national nutrition standards including the Dietary Guidelines for Americans and the Dietary Reference Intakes. As a result, they are lower in sodium and unhealthy fats, making them appropriate for common conditions such as heart disease and hypertension. Additional therapeutic meals may be ordered by a physician, and other nutrition supports are available (e.g nutrition education, nutrition counseling, specialized eating utensils, or oral nutrition supplements).
Utilizing the Existing OAA Framework
The OAA nutrition program already operates within a long-standing federal-state-local framework administered by the U.S. Department of Health and Human Services, reducing the need for the MTM pilot to create a new structure. The OAA aging services network also stretches federal investments. For every federal OAA dollar provided, the aging services network leverages another four dollars from state, local, and private sources. Building on this framework would reduce administrative burden, strengthen existing healthcare-OAA program partnerships, and identify a standardized MTM service model to ensure the long-term sustainability of the MTM program. As HHS Secretary Robert Kennedy has noted, “Meals on Wheels is not just a nutrition and malnutrition prevention program, it’s a great investment with enormous returns.”
The OAA nutrition program also operates under established quality standards and reporting systems. State and Area Agencies on Aging ensure accountability through regular monitoring, financial accountability, conflicts of interest prohibitions, compliance with state and local food safety regulations, and emergency preparedness. These safeguards have helped build a trusted national network while maintaining participant choice and strong outcomes (See Table 1).
Table 1: Reports Demonstrating Potential Benefits of Medically Tailored Meal (MTM) Pilots Partnering with OAA Nutrition Programs to Deliver MTMs
| Study or Report | Findings from OAA Nutrition Programs |
| 2024 National Survey of Older Americans Act Participants | For home-delivered meal recipients: 85% say they eat healthier because of the program 93% feel the program helped them to live independently 88% rate the meals as good or excellent |
| 2025 Clinical Trial of Home-Delivered Meals | OAA nutrition programs: Reduced hunger and food insecurity by providing consistent access to nutritious meals Fostered meaningful social connections, reduced loneliness, improved physical and emotional well-being, supported independence, and helped older adults remain in their homes |
| 2018 Evaluation of the Effect of the Older Americans Act Title III-C Nutrition Services Program on Participants’ Health Care Utilization | OAA nutrition programs are effective in significantly reducing healthcare expenditures |
| 2024 Academy of Nutrition and Dietetics Evidence Analysis Center Guideline and the 2021 U.S. Community Services Preventive Task Force Recommendations | Recommend home-delivered meals due to their effectiveness in reducing malnutrition, increasing energy intake, and improving health-related quality of life and well-being |
Next Steps
Expanding access to Medically Tailored Meals is an important step toward improving management of chronic disease and food-related medical conditions in older adults and those with disabilities. However, meals alone are not enough. MTM providers must adhere to established standards, ensure safety and oversight, and demonstrate the ability to support ongoing care and community partnerships. We therefore urge that the H.R.5439/S.2834 MTM pilot include language requiring hospitals to engage with the OAA nutrition program as the primary MTM community-based partner. OAA program planners could then determine whether to provide MTM directly or oversee another appropriate provider that meets the hospital’s criteria. This approach will maximize the pilot’s potential to demonstrate improvements in older Americans’ nutrition, quality of life, hospital-community care coordination, and ultimately health outcomes and healthcare costs.
Shirley Chao, PhD, RDN, FAND is the Principal at FoodPolicy Insights and formerly Director of Nutrition of the Massachusetts Executive Office of Elder Affairs and was the co-chair of the Massachusetts Malnutrition Commission.
Judy Simon, MS, RD, LDN is a Nutrition and Health Promotion consultant and former National Nutritionist at the Administration for Community Living.
Laura Borth, MS, RDN, CD is the Policy Director at The National Association of Nutrition and Aging Services Programs (NANASP)
Johanna Dwyer, DSc, RDN is Professor, School of Medicine and Friedman School of Nutrition Science and Policy and Senior Nutrition Scientist, Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston.
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