Objective: This dissertation examines the roles that stakeholders play in Medicaid waiver policies to support Food Nutrition Services (FNS) for people with Type II Diabetes.

Research Design and Methods: A mixed-method approach was selected for this research. Two qualitative techniques were deployed, manifest and latent content analysis of Medicaid Home and Community Based Service (HCBS) 1915(c) waivers and semi-structured telephone interviews with stakeholders. The stakeholders selected for this research were: (1) policymakers, (2) Medicaid Insurers, (3) FNS providers, and (4) FNS participants. One quantitative method was deployed to calculate descriptive statistics on healthcare outcomes and costs for FNS participants.

Results: The results of the manifest and latent content analysis suggest that 37 states are using Medicaid HCBS 1915(c) waivers to provide home-delivered meals for specific populations. No states specify that the meals must be medically tailored to a participant’s illness. The phrase “Type II Diabetes” was present in 17% of the waivers in this analysis. The results of the stakeholder interviews suggest: 1) politics plays a large role in Medicaid waiver policy; 2) membership within the Food Is Medicine Coalition offers providers with resources and advocacy capacity; 3) FNS participants were divided on the role that FNS played with respect to their Type II Diabetes. The descriptive statistics show reductions in clinical outcomes and healthcare utilization.

Conclusion: The findings offer insight into the role that stakeholders play within Medicaid waiver policies to support FNS. Medicaid HCBS 1915(c) waivers can be used to provide FNS for beneficiaries, however advocacy is required to specify meals be medically tailored. Stakeholders need to form strong partnerships with natural allies as well as unconventional partners. Data is critical to informing policy decisions, however there is limited access to clinical outcomes and the collection of data lacks rigor in order to assess the efficacy of FNS.