Medically tailored meals receipt and healthcare utilization and costs in Massachusetts' Medicaid demonstration.

Smaller quasi-experimental studies and short-term controlled trials of medically tailored meals (MTMs) have shown health benefits for several conditions, but MTMs have not been evaluated in large-scale policy initiatives. Multiple US states are now implementing MTMs in Medicaid, the health insurance program for low-income individuals, yet their impact has not been evaluated. We investigated changes in hospitalizations, emergency department (ED) visits and healthcare costs among 1,866 MTM recipients and 1,372 comparators from 2020 to 2023 across 11 health systems in Massachusetts. Both groups met eligibility criteria for diet-related conditions and food insecurity. We used propensity overlap-weighted generalized estimating equations to compare a 6-month baseline period to the program period. MTM receipt (mean, 6.7 months) was associated with 31% fewer hospitalizations (adjusted incidence rate ratio (aIRR) = 0.69 (95% confidence interval (CI): 0.58-0.82)), 20% fewer ED visits (aIRR = 0.80 (95% CI: 0.72-0.89)) and US$3,433 lower total healthcare costs (95% CI: $-1,215 to -$5,651). Healthcare cost reductions offset 98% of the MTM program costs during the enrollment period. Findings were robust across sensitivity analyses, a negative control test and a secondary comparison group. In stratified analyses, MTM receipt was net cost-saving among participants with cardiovascular disease, chronic kidney disease, depression, diabetes or high comorbidity. This large MTM policy evaluation informs consideration of 'food is medicine' therapies in clinical care.