Food Is Medicine (FIM) has rapidly evolved from a collection of small, grant-funded pilots into a central strategy in state and federal health policy. With new investments emerging through Medicaid waivers, CMS Innovation models, and state rural health initiatives, FIM programs are now recognized as a powerful tool for improving chronic disease management, reducing hospital use, lowering costs, and supporting whole-person care.
The success of Food Is Medicine programs, especially in rural communities, depends on more than access to healthy food. It depends on the people who help families use that food in practical, culturally relevant, and sustainable ways. Across the country, community health workers (CHWs), promotoras, and community health representatives are playing that essential role.
What Is Food Is Medicine?
Food Is Medicine (FIM) refers to a set of clinical and community-based interventions that provide nutritious food or nutrition support to prevent, manage, or treat chronic health conditions. Common approaches include produce prescriptions, medically tailored meals, grocery subsidies, and nutrition education delivered in partnership with health care providers.
Once viewed as an innovative but peripheral strategy, FIM is now becoming a mainstream part of chronic disease management, with increasing evidence showing that healthy food delivered through the health care system can improve outcomes, reduce hospital use, and lower costs.
The Rise of Food Is Medicine in Rural Health Transformation
Rural communities face unique challenges that shape their ability to benefit from food access programs: limited grocery options, transportation barriers, fluctuating benefit rules, high costs for fresh foods, and widespread chronic disease. Food Is Medicine programs offer an opportunity to directly address these barriers, but only when they are paired with trusted, community-based support.
CHWs bridge the gap between clinical nutrition strategies and the realities of rural life. They bring lived experience, cultural alignment, and an understanding of local food systems that traditional care teams often lack. Their involvement ensures that nutrition prescriptions, produce subsidies, and meal kits become actionable tools rather than one-time interventions.
Why CHWs Are Essential to Effective FIM Implementation
CHWs make Food Is Medicine interventions work in ways that no other workforce can. They:
- Build trust with families through shared culture, language and lived experience
- Provide hands-on support to apply nutrition guidance into daily routines
- Help families stretch limited budgets and plan meals with affordable, accessible ingredients
- Navigate transportation barriers and connect residents with local food hubs, farmers, and markets
- Support benefit applications (SNAP, WIC, produce prescriptions) and troubleshoot gaps
- Collect stories and outcome data that reveal why some interventions succeed while others stall
- Extend care into kitchens, grocery aisles, community centers, and school cafeterias
Because of this direct, relationship-based approach, CHWs are central to making rural Food Is Medicine programs both effective and sustainable.
Evidence: Choice, Flexibility, and CHW Support Improve Outcomes
Emerging research reinforces that food interventions work best when families can choose foods that align with their preferences, routines, and cultural traditions.
A recent Healthy Food First clinical study in North Carolina found that offering a modest monthly produce subsidy led to greater improvements in blood pressure than providing pre-selected boxes of food. Participants who could choose foods that fit their preferences and family routines experienced better outcomes.
CHWs play an essential part in this model of empowerment. They help families:
- Understand how to use grocery cards
- Apply nutrition guidance in culturally relevant ways
- Plan for limited storage or cookware
- Navigate transportation barriers
- Balance food costs with competing household expenses
This combination of choice plus CHW support is a proven formula that strengthens Food Is Medicine outcomes across rural communities.
How States Are Integrating CHWs into Rural Food Is Medicine Strategies
Among states that are focusing on FIM in their Rural Health Transformation Program applications, CHWs are increasingly being embedded into Food Is Medicine strategies. Examples includes:
Arkansas – HEART and FARM Initiatives
These programs aim to expand access to local produce, enhance nutrition education, and build healthier food environments in rural regions. CHWs serve as the connectors between clinics, food hubs, and community partners—helping residents navigate new resources and supporting long-term change.
North Carolina – ROOTS Hubs
The state plans to scale healthy grocery boxes, mobile markets, and farm-to-hospital programs. CHWs are being explicitly funded to deliver hands-on nutrition education, budgeting assistance, and culturally aligned food preparation support.
Delaware – Food Is Medicine Infrastructure Initiative
Delaware proposes dedicated CHW staffing in rural practices, alongside tele-nutrition tools and culinary medicine consultations.
Kansas – Accountable Food Is Medicine
Kansas will deploy CHWs across rural clinics and behavioral health centers, where they will anchor its nutrition interventions and help align clinical teams with local food system partners.
Across these models, CHWs serve as the connective tissue that makes Food Is Medicine operational—and impactful.
What States Should Consider When Designing Rural FIM Programs
To build strong Food Is Medicine strategies under the Rural Health Transformation Program, states should prioritize:
- CHW workforce capacity and sustainable funding
- Culturally relevant nutrition coaching tailored to rural populations
- Flexible benefit structures that prioritize consumer choice
- Transportation solutions that make it possible to access grocery stores and markets
- Data systems that track FIM outcomes, barriers, and cost savings
- Strong food ecosystem partnerships with farmers, food hubs, and local organizations
When CHWs are equipped and supported, Food Is Medicine programs can scale more effectively and reach more families.
Conclusion: CHWs Make Food Is Medicine Work
In an era of tightening budgets and rising chronic disease, the path forward for rural health depends not just on providing healthy food, but on supporting the people who help families use it. Food Is Medicine programs thrive when CHWs are empowered to do what they do best: build trust, solve problems, and help individuals make everyday choices that lead to healthier lives.